GENERAL SUMMARY
Responsible for coding and building provider demographic and payment information and/or client provider network information into the transactional system and other databases. Works with customer service/claims, account management, Information Administrators, and/or Provider Service Representatives to find solutions for provider contract, group data, and claims issues. May provide support to the health plan and customer service/claims department regarding system capabilities and limitations. May serve as technical resource on products and technology.
ESSENTIAL RESPONSIBILITIES
- Evaluates and builds provider demographic, contract, and/or client provider network information into the transactional system and other databases.
- Extracts data from the transactional system for analysis and system setup.
- Facilitates resolution of provider, group, or contract related claims issues.
- Supports accurate claims auto-adjudication and accurate claims payment.
- Supports Information Administrators in servicing health plans and customer service/claims by providing data used to develop new products and strategies.
- Acts as an interface between health plans and customer service/claims.
- Interfaces with Information Administrators regarding transactional systems and customer service operations processes.
- Participates in business improvement project teams.
- Participates in cross-functional user groups to optimize the use of existing transactional systems and reports.
- Performs other duties as required.
Qualifications:
JOB SPECIFICATIONS
- High school degree or equivalent. Bachelor's degree preferred.
- Previous (1-2 years) provider maintenance, claims processing or coding experience preferred.
- Thorough knowledge of coding (CPT, REV, ICD-9, HCPCS).
- Proficiency in Excel required, knowledge of Access desired.
- Strong organizational skills.
- Good communication skills, both written and verbal.
- Ability to work on cross-functional teams.
Coventry Health Care is an Affirmative Action/Equal Opportunity Employer, and we are committed to building a talented and diverse team.
Job: Professionals
Primary Location: West Sacramento, CA, US
Organization: 10750 - Service Center - Central Admin
Schedule: Full-time
Job Posting: 2013-01-31 00:00:00.0
Job ID: 1310413