Jobs
>
Phoenix

    Provider Data Resolution Specialist - Phoenix, United States - TriWest Healthcare Alliance

    TriWest Healthcare Alliance
    TriWest Healthcare Alliance Phoenix, United States

    3 weeks ago

    Default job background
    Description
    We offer remote work opportunities (AK, AR, AZ, CA, *CO, FL, *HI, IA, ID, IL, KS, LA, MD, MN, MO, MT, NE, NV, NM, NC, ND, OK, OR, SC, SD, TX, UT, VA/DC, *WA, WI and WY only)

    Veterans, Reservists, Guardsmen and military family members are encouraged to apply

    Job Summary


    Ensures accurate, timely maintenance, and synchronization of critical Provider data on all Provider databases, and systems such as Claims, Data Management, and Authorization/Referral systems.

    Accesses and utilizes multiple software applications.

    Applies business rules and knowledge of Provider contract language, pricing and reimbursement methodologies to each database/system to validate Provider information in all systems.

    Communicates with internal and external customers by phone and email to clarify data and follow-up on issues, working under timeline, accuracy and production targets.

    Requires the ability to manage a large amount of complex information, communicate clearly, and draw sound conclusions.

    Performs simple credentialing activities including performing primary source verifications and entering the initial data of potential Providers into the Provider database and credentialing system(s).

    Collaborates with the Provider Data Specialists and provides clear instructions to correct data issues. Ensures correct reimbursement and Provider data is housed in all downstream systems.

    Education and Experience


    Required:
    High School Diploma or GED 2 years of varied responsible experience with computer database programs 2 years of Health Care experience such as claims, provider data or authorization or referral processing Experience with Microsoft Suite (including, but not limited to, Word, Excel and Outlook)

    Preferred:

    1+ years of Health care claims resolution experience Experience using a Provider Data Management System, Claims System, or Authorization/Referral system

    Key Responsibilities

    Resolves Provider data discrepancies related to claims processing, including contract reimbursement rates within the allotted timeframe. Manages daily follow up of Provider data correction requests and issues to ensure databases are current and accurate. Ensures and maintains accurate data within the Provider Claims and Authorization databases. Contacts providers to verify all credentialing, claims, and billing information. Ensures appropriate tax documentation is obtained and imaged for Provider files. Corrects reimbursement issues within claims payment system. Develops, maintains, and processes reimbursement terms ensuring correct claims payment and downstream processing. Reviews Provider contract language and identifies when a contract is out of compliance.

    Processes Provider contracts, run reports, and responds to inquiries regarding contract compliance issues; images and indexes contracts and return images to network subcontractors; conducts quality assurance activities to ensure image quality and completion of image activities.

    Queries primary sources and OIG, as applicable, to verify Provider credentials and qualifications.

    Professionally and concisely communicates in writing and by phone, information and/or instructions for updating and correcting databases. Resolves 1099 and W9 discrepancies. Assist in the development and update of protocols and procedures. Coordinates with Claims and other departments on Provider database related issues. Resolves daily error reports which include data rejected from claims system including data rejecting from all downstream systems. Performs other duties as assigned. Regular and reliable attendance is required.

    Competencies

    Commitment to Task:
    Ability to conform to established policies and procedures; exhibit high motivation


    Communication / People Skills:
    Ability to influence or persuade others under positive or negative circumstances; adapts to unique styles; listens critically; collaborates


    Computer Literacy:
    Ability to function in a multi-system Microsoft environment using Word, Outlook, TriWest Intranet, the Internet, and department software applications


    Coping / Flexibility:
    Resiliency in adapting to a variety of situations and individuals while maintaining a sense of purpose and mature problem-solving approach


    High Intensity Environment:
    Ability to function in a fast-paced environment with multiple activities occurring simultaneously while maintaining focus and control of workflow


    Organizational Skills:
    Ability to organize people or tasks, adjust to priorities, learn systems, within time constraints and with available resources; detail-oriented


    Problem Solving / Analysis:
    Ability to solve problems through systematic analysis of processes with sound judgment; has a realistic understanding of relevant issues


    Technical Skills:
    Proficient with key databases, including Claims System, Medical Management System, Authorization/Referral Systems, and Provider Information Management System(s); working knowledge of claims reimbursement methodology and medical coding; healthcare or managed care experience

    Working Conditions


    Working Conditions:


    Availability to cover any work shift Works within a standard office environment, with minimal travel Extensive computer work with prolonged periods of sitting Must be a U.S.

    Citizen Must be able to receive a favorable Interim and adjudicated final Department of Defense (DOD) background adjudication Annual base salary for Colorado, Hawaii and Washington State residents:
    $35,000- $45,000 depending on experience
    #J-18808-Ljbffr
  • Redirect Health

    Claims Resolution Specialist

    2 weeks ago

    Redirect Health Phoenix, United States

    **Free Healthcare for you and your family, what does that mean?** · - **You should not have to worry about the burden of cost when it comes to healthcare for you and your family, we are here to remove that burden.**: · - **The average family will spend close to $20,000 a year bef ...

  • Redirect Health

    Claims Resolution Specialist

    2 days ago

    Redirect Health Phoenix, United States

    **Free Healthcare for you and your family, what does that mean?** · - **You should not have to worry about the burden of cost when it comes to healthcare for you and your family, we are here to remove that burden.**: · - **The average family will spend close to $20,000 a year bef ...

  • Risas Dental and Braces

    Patient Account Resolution Specialist

    1 week ago

    Risas Dental and Braces Phoenix, United States

    At Risas Dental and Braces, our focus is providing quality and affordable dental care and braces for families everywhere. Our goal is to think and speak a language that patients understand. For this reason, our Company Statement is We Speak Patient. The result is happier, healthi ...

  • Valon

    Resolution Specialist

    2 weeks ago

    Valon Phoenix, United States Full time

    · About the Company · Valon's mission is to empower every homeowner. We believe the journey of home ownership starts when you get your keys, but lasts far beyond. We're creating a world where home ownership comes with ease, security, and financial know-how. Our growing team of e ...

  • Valon

    Resolution Specialist

    2 weeks ago

    Valon Phoenix, United States

    Job Description · Job DescriptionAbout the Company · Valons mission is to empower every homeowner. We believe the journey of home ownership starts when you get your keys, but lasts far beyond. Were creating a world where home ownership comes with ease, security, and financial kno ...

  • SA Technologies Inc

    Error Resolution Specialist

    3 weeks ago

    SA Technologies Inc Phoenix, United States

    Job Description · Role : Error Resolution Specialist · Estimated Duration : 6+ months · Location: Phoenix, AZ (hybrid) · Position Description · This position works independently to Research, Analyze and Validate documents and payments that require a more detailed review. Thi ...

  • SA Technologies Inc

    Error Resolution Specialist

    2 weeks ago

    SA Technologies Inc Phoenix, United States

    Job DescriptionRole : Error Resolution SpecialistEstimated Duration : 6+ monthsLocation: Phoenix, AZ (hybrid)Position DescriptionThis position works independently to Research, Analyze and Validate documents and payments that require a more detailed review. This position will cons ...

  • First Credit Union

    Account Resolution Specialist/collections

    3 weeks ago

    First Credit Union Chandler, United States

    **_ACCOUNT RESOLUTION SPECIALIST/COLLECTIONS_** · **_ AZ CENTRAL TOP COMPANIES TO WORK FOR IN ARIZONA 2023_** · As Account Resolution Specialist your primary responsibility will be outbound contact for payment reminders to members. Confers with member by telephone in attempt to d ...

  • Arizona Department of Revenue

    Error Resolution Specialist 1

    3 weeks ago

    Arizona Department of Revenue Phoenix, United States

    ARIZONA DEPARTMENT OF REVENUE · Funding Arizona's future through excellence in innovation, exceptional customer service and public servant-led continuous improvement.All Arizona State employees operate within the Arizona Management System (AMS), an intentional, results-driven app ...

  • TriWest Healthcare Alliance

    Provider Data Resolution Specialist

    2 weeks ago

    TriWest Healthcare Alliance Phoenix, United States

    We offer remote work opportunities (AK, AR, AZ, CA, *CO, FL, *HI, IA, ID, IL, KS, LA, MD, MN, MO, MT, NE, NV, NM, NC, ND, OK, OR, SC, SD, TX, UT, VA/DC, *WA, WI and WY only) · Veterans, Reservists, Guardsmen and military family members are encouraged to apply · Job Summary · Ensu ...

  • Farmers Insurance

    Claims Resolution Specialist-Hybrid

    3 weeks ago

    Farmers Insurance Phoenix, United States

    We are Farmers · We are... more than just your favorite commercials. At Farmers, we strive to deliver peace of mind to our customers by providing protection and comprehensive advice and delivering in the moments of truth. That means having people who can help us meet changing cu ...

  • Farmers Insurance

    Claims Resolution Specialist-Hybrid

    3 weeks ago

    Farmers Insurance Phoenix, United States

    We are Farmers · We are... more than just your favorite commercials. At Farmers, we strive to deliver peace of mind to our customers by providing protection and comprehensive advice and delivering in the moments of truth. That means having people who can help us meet changing cu ...

  • Endpoint Closing, Inc.

    Resolution Specialist

    3 weeks ago

    Endpoint Closing, Inc. Tempe, United States

    Endpoint is a digital title and settlement company built from the ground up to make home closing easy for all. For many, buying or selling a home is one of life's biggest transactions. At Endpoint, we help our customers close every deal so they can start their next chapter with c ...

  • Endpoint Closing Inc.

    Resolution Specialist

    3 weeks ago

    Endpoint Closing Inc. Tempe, United States

    Endpoint is a digital title and settlement company built from the ground up to make home closing easy for all. For many, buying or selling a home is one of lifes biggest transactions. At Endpoint, we help our customers close every deal so they can start their next chapter with co ...

  • Servbank

    Customer Resolution Specialist

    3 weeks ago

    Servbank Gilbert, United States

    Job Description · Job Description Description: Walking into the Servbank office you instantly feel the energy of our team. The bright and colorful space creates a casual happy environment. The connection you feel from the smiling faces and team comradery will make you feel right ...

  • First Credit Union

    Account Resolution Specialist

    3 weeks ago

    First Credit Union Chandler, United States

    Job Details · Job Location · Chandler Corporate - Chandler, AZ · Position Type · Full Time · Description · Summary/Objective · Responsible for collecting on accounts while balancing the goodwill of members with the overall business interest of FCU. Locate and notify members ...

  • First Credit Union

    Account Resolution Specialist

    1 week ago

    First Credit Union Chandler, United States

    Job DetailsJob LocationChandler Corporate - Chandler, AZPosition TypeFull TimeDescriptionSummary/ObjectiveResponsible for collecting on accounts while balancing the goodwill of members with the overall business interest of FCU. Locate and notify members of delinquent accounts by ...

  • First Credit Union

    Account Resolution Specialist

    1 week ago

    First Credit Union Chandler, United States

    Job Details · Job Location · Chandler Corporate - Chandler, AZ · Position Type · Full Time · Description · Summary/Objective · Responsible for collecting on accounts while balancing the goodwill of members with the overall business interest of FCU. Locate and notify members o ...

  • Servbank

    Customer Resolution Specialist

    1 week ago

    Servbank Gilbert, United States

    Job Description · Job DescriptionDescription:Walking into the Servbank office you instantly feel the energy of our team. The bright and colorful space creates a casual happy environment. The connection you feel from the smiling faces and team comradery will make you feel right at ...

  • First Credit Union

    Collections/Account Resolution Specialist

    3 weeks ago

    First Credit Union Chandler, United States

    COLLECTIONS/ACCOUNT RESOLUTION SPECIALIST · AZ CENTRAL TOP COMPANIES TO WORK FOR IN ARIZONA 2023 · First Credit Union was established in 1929 with the proud distinction as Arizona's "first" credit union. Since then, we've been dedicated to delivering quality products and serv ...