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Highmark Health
Provider File Representative SeniorHighmark Health • OK, Working at Home, Oklahoma
Provider File Representative Senior

Provider File Representative Senior

Highmark Health • OK, Working at Home, Oklahoma
30+ days ago
Job type
  • Full-time
Job description

Description

:

GENERAL OVERVIEW:
This position is responsible for corporate provider enrollment and provider file maintenance across all markets. This includes, enrollment, contracting and demographic provider information. Incumbent ensures compliance with BCBS and CMS requirements, DOH regulations, internal, private business and governmental audits. Responsible for reviewing and processing additions, updates, and deletions of provider information in the Provider File database. Ensures executions of data entry and updates are completed in a timely and accurate manner.


ESSENTIAL RESPONSIBILITIES

  • Maintain accurate data in provider file data systems. Common transactions include: Maintaining and initial setup of assignment accounts (AA) from the AA applicationsUpdating group and provider affiliations from AFBs and written requests 1099 tax ID updates UPIN/PTAN and/or Medicare Welcome Letter information State license update Enumerating providers Name changes, demographic data updates, specialty changes Hospital affiliations, network affiliations, network terminations Facility Agreement data, Institutional non-contracted files.
  • File Maintenance Analysis. Applying complex and detailed guidelines in the review process of the submitted requestsThe documentation application must comply with BCBS, DOH, CMS, MSBCBS and Highmark requirements. Routinely contact external sources such as the Provider offices, state licensing agencies and provider reps to collect or clarify information or documentation, which in turn must be reviewed and evaluated against the established guidelinesEnsure the file meets all regulations prior to updating the provider file
  • Data Integrity. Contact external sources to collect or clarify information or documentation which in turn must be reviewed and evaluated against the established guidelines and procedures to ensure the file meets all policy and procedures in conjunction with regulations. Maintain and update internally required data elements which include but are not limited to: Assigned Blue Shield provider numbersNational Provider Identifier (NPI)CMS required provider identifiers for compliance with corporate and federal contracts.This individual will be also responsible to educate providers for obtaining and updating provider identifiers.
  • Other duties as assigned or requested.

QUALIFICATIONS
Minimum

  • High School Diploma or GED
  • 5-10 years of related, progressive experience

Language (Other than English):

None

Travel Requirement:

0% - 25%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

Office-based

Teaches / trains others regularly

Occasionally

Travel regularly from the office to various work sites or from site-to-site

Rarely

Works primarily out-of-the office selling products/services (sales employees)

Never

Physical work site required

Yes

Lifting: up to 10 pounds

Constantly

Lifting: 10 to 25 pounds

Occasionally

Lifting: 25 to 50 pounds

Rarely

Pay Range Minimum:

$22.71

Pay Range Maximum:

$35.88

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.

We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below.

For accommodation requests, please contact HR Services Online at

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Provider File Representative Senior • OK, Working at Home, Oklahoma

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