Provider Administrator Analyst

Key Responsibilities

• Reviews and analyses executed provider contracts for accuracy, completeness, and administrability.

• Identifies non programmable contracts and returns to management for discussion.
• Offers solutions both temporary and permanent to assist in contract management.
• Identifies contracts missing required information and supporting documentation and returns to requester.

• Enters acceptable provider contracts into the Provider File Maintenance module so that proper claims adjudication, utilization management, and provider directories can occur.
• Reviews pended claims due to issues with providers and assists in the resolution of the provider edit.
• Create systemic rate schedules and attaches to entered provider contracts so that automated and proper claims pricing can occur as well as monthly capitation payments.
• Coordinates provider contracts with the Provider Credentialing Department for purposes of ascertaining a provider’s credentialed status and effectiveness in the system upon monthly committee meetings.
• Provides support to Provider Claims Customer Service as needed.
• Creates and maintains Provider Web Portal Accounts for contracted providers.
• Maintains a broad knowledge of CMS, Medicaid and state regulations as it relates to provider administration.
• Maintains a productive working relationship with all departments outside provider administration.
• Maintains a broad knowledge of all systems and related modules that access the provider administration databases.
• Ensures integrity of data entered into company systems and/or databases.
• Ability to safely and successfully perform essential job functions consistent with the ADA, FMLA, and other federal, state, and local standards, including meeting qualitative and/or quantitative productivity standards.
• Ability to maintain reasonably regular, punctual attendance consistent with the ADA, FMLA, other federal, state, and local standards, and company attendance policies and procedures.
• Ability to come to work and work the regular schedule and shift for the position.
• Complies with and/or adheres to company HIPAA policies and procedures.

Qualifications:

• Associate Associates Degree (AS, AA) or three years related experience and/or training; or equivalent combination of education.
• Minimum 3 years’ experience in a medical office claims operation environment with increasing levels of responsibility in the area of Provider Administration.
• Demonstrated knowledge of Provider Administration in a medical claims environment.

Location:

Position is remote and the location of candidate is flexible within the U.S.