Provider Enrollment Analyst - Wisconsin Rapids, United States - Quartz

Description

Overview

Quartz is thrilled to offer opportunities for professional growth in our Provider Enrollment Department.

The Provider Enrollment Analyst will build and maintains Practice Locations, Facilities, Practitioners and Contracts in both the Provider Database and the company's claim processing system.

This position will maintain accuracy and timely data entry including quarterly verification of provider data in compliance with the No Surprise Act and NCQA guidelines.

Benefits
:
Supportive team environment with strong relationships & bondAbility to make a positive impact in a quickly growing, faced paced organizationExcellent mentoring, learning and growth opportunitiesBased compensation range:
$51,000 - $63,000Responsibilities

Build and maintain provider and facility records including adds, changes and terminations within the claims adjudication system (HealthLink).

Sets up and maintains provider (SER), facility (FAC), place of service (POS), PCP Location (LOC), PCP status, and network records for adds, changes and terminations for contracted providers.

Processes updates to vendor (VEN) records, 835 and EFT builds, and add claim alerts when needed.
Preps and loads provider information into HealthLink through an import spreadsheet and direct entry and maintenance in HealthLink.

Builds and maintains Practice Locations, Facilities, Practitioners and Contracts in the Provider Database (eVIPs).

Sets up and maintains Contracts, Facilities, Practice Locations, Practitioners, and networks. for adds, changes and terminations for contracted entities.

Enters and maintains providers, practitioners, and facilities while linking them to the contracts and networks including prepping and loading data manually, through dynamic import utility, through BOT automation, and mass update and mass insert processes.

Configures and maintains Data Masters, Reference tables, Networks and Address Masters.
Performs provider licensure, NPI, Medicare and Medicaid validation.

Performs departmental and corporate project work and other duties as assigned by Manager.

Conducts query requests and runs ad-hoc reports as needed.
Submits Provider and Facility rosters for self-funded business.

Conducts research based on claims received, communication from the providers, and source verification documentation for responding to CRMs, providers, and claims inquiries.

Qualifications

2+ years of health claims process or provider data experienceFamiliar with health insurance or healthcare industry; medical billing experience preferredExperience with Microsoft products; proficient in MS Excel and WordEpic and/or eVIPs knowledge is desirableStrong analytical skills and ability to do complex problem solvingAbility to work independently, with minimal supervisionExcellent written and verbal communication skills

Bilingual candidates encouraged to apply

This full-time position will have the opportunity to work remotely or hybrid at one of our offices located in Madison, WI or Onalaska, WI.

Individuals must have access to high-speed, non-satellite Internet to successful work from home.

We offer an excellent benefit and compensation package, opportunity for professional growth and a professional culture built upon the foundation of Respect, Responsibility, Relationships & Resourcefulness.

Quartz is a federal contractor and supports a safe, drug-free workplace. All employment offers are contingent upon successful completion of a pre-employment criminal background check.

Quartz values and embraces diversity and is proud to be an Equal Employment Opportunity, Affirmative Action employer.

All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex, gender identity or expression, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability.

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