Medical Claims Processor

Description:

Responsible for entering and maintaining provider demographic and contractual data within the claims processing system and working with various departments to answer questions regarding information configured within the provider database. WHAT IS EXPECTED (ESSENTIAL FUNCTIONS)Maintains provider database, utilizing credentialing data, the National Plan & Provider Enumeration System (NPPES) and other data sources to ensure data integrity within the claims processing system. Works in conjunction with Network Development to enter new contracts into the system and make modification to existing contracts. Collects IRS W-9 forms from providers to validate/update configured information. Collaborates with enrollment operations to effectively coordinate member re-assignment upon termination of a Primary Care Provider (PCP).Assists in the selection of the appropriate pricing template to apply to contracts. Works in conjunction with the Compliance Department to update provider records as appropriate when notified of credible allegations of fraud and identify any claims paid during the alleged period. Provides assistance with both simple and complex administrative tasks, including but not limited to, entry and validation of data for multiple departments. Ensures that provider federal tax information found to be in error as identified through IRS B-Notice is updated. Responsible for updating provider configuration as appropriate when notified of an IRS Notice of Levy. Reviews provider quality reports and update provider records as appropriate to bring configuration in line with company standards. Aids in the development of new policies and procedures needed as new issues arise and assists in creating business and system requirements to improve the management of provider data. Performs other position appropriate duties as required in a competent, professional and courteous manner.

Skills:

claims processing, medical insurance, data entry, amisys

Top Skills Details:

claims processing,medical insurance,data entry

Additional Skills & Qualifications:

2 years of claims processing 2 years of health insurance Proficiency with Microsoft Excel Experience with Amisys Advance preferred but not required

Experience Level:

Entry Level

About TEKsystems:

We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company.

The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.