Provider Maintenance Specialist

Centivo is looking for a Provider Maintenance Specialist to join our team!

As a Provider Maintenance Specialist, you will focus on maintaining accurate and up-to-date provider data in our claims system in support of claim adjudication. This role will involve provider outreach for demographic validation, be the liaison for claims team and provider relations. Additionally, develop and maintain standards for system integrity, and identify trends working closely with other internal teams.

What you'll do:

• Perform baseline demographic transaction updates in provider system applications in support of claim adjudication.
• Conduct audits of provider information and escalates issues for resolution as appropriate, including provider outreach via outbound calls for demographic validation.
• Liaison with the claim team to resolve provider matching rules and provider relations to resolve provider affiliation and roster issues.
• Interface with internal and external departments to resolve all high-level provider record, contract, and reimbursement issues, both provider and clients.
• Develop and maintain standards for system integrity, corrective actions, system alignment, and manage communication processes with other departments regarding system improvements.
• Perform workflow analysis; recommend modifications, quality enhancements to streamline processes and increase productivity in those specific areas.
• Conduct other duties as requested by the Manager to ensure directives are carried out and departmental goals are met.

You should have:

• Knowledge of healthcare industry and regulations
• Strong analytical, problem-solving, and critical thinking skills.
• Excellent attention to detail
• Strong communication and interpersonal skills
• Proficient in Microsoft Office Suite and other web-based software applications
• Ability to adapt quickly to changing priorities.
• Proven ability to work in a fast-paced environment managing multiple issues with pressure of production schedules and deadlines.

Education and Experience:

• 2 years of work experience in healthcare
• Experience in processing claims
• Customer service experience
• Knowledge of healthcare provider networks, contracting and onboarding requirements preferred.
• Javelina experience is a plus, high efficiency with tool is a bonus

Work Location:

• This position is remote or in the Buffalo office.