If you are looking for a career in the health care industry, but prefer an office environment, this could be the right opportunity for you. Coventry Health Care is currently recruiting a Provider Systems Specialist in our Franklin, TN Service Center. The ideal candidate will be responsible for reviewing provider applications or profiles and build provider demographics and payment information into the transactional claims system and other databases.
ESSENTIAL RESPONSIBILITIES
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Processes and maintains enrollment and eligibility records with 200 plus providers.
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Manages daily inventory and quality within a specified metric along with providing daily/weekly edit reports.
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Works with other departments to resolve provider claim issues.
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Interfaces with provider groups by telephone and/or correspondence to verify group information.
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Maintains complete accurate documentation of all customer interactions and maintain production levels and quality goals.
- Researches and audits provider records by effectively using internal and proprietary technical tools in response to inquiries including, but not limited to, authorizations, payments, denials, coordination of benefits, and enrollment eligibility.
- Informs network of any changes to provider contracts.
- Understands the teams' performance against measured service operation goals and accepting ownership for individual and team results.
- Identifies and initiate process improvements.
- Performs other duties as required. Qualifications:
JOB SPECIFICATIONS
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High school degree or equivalent.
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1-2 years experience with claims processing, enrollment, and customer service
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Knowledge of health care products, medical terminology, diagnosis and procedure coding, and coordination of benefits.
- Effective keyboarding skills with a minimum typing requirement of 25 wpm
PREFERRED QUALIFICATIONS
- Basic working knowledge of MS Office applications including Excel and Access database.
- Knowledge of IDX member inquiry (F49).
OTHER
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Highly self-motivated and able to work well under stress in a fast-paced environment.
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Excellent organizational aptitude and high attention to details.
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Demonstrates responsiveness and a sense of urgency when dealing with customers.
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Effective verbal and written communication skills.
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Strong analytical and problem-solving skills.
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Ability to maintain production levels and quality goals
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Strong organizational skills with the ability to multi-task well.
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Must be able to absorb and apply new and changing information.
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Possess ability to maintain production levels and quality goals.
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Able to maintain regular and consistent attendance in accordance with company and departmental policies and procedures.
- At Coventry Health Care, we've been building a world-class Customer Service Organization that delivers an easy and simple experience for our customers. We need the right people on the front line to make a different with our members, health care providers and even each other as we work together as a team.
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- We offer a competitive salary, excellent benefits (401k with company matching, paid training, comprehensive benefits including medical, dental, tuition reimbursement), vacation and sick time, and a business causal environment. This is a fast-paced, hands-on, team-oriented environment where creativity, initiative and innovation are highly rewarded.
Please apply directly and refer to Req# 1310488.
Coventry Health Care is an Affirmative Action/Equal Opportunity Employer, and we are committed to building a talented and diverse team.
Job: Administrative Support Workers
Primary Location: Franklin, TN, US
Organization: 10750 - Service Center - Central Admin
Schedule: Full-time
Job Posting: 2013-02-11 00:00:00.0
Job ID: 1310488