The Provider Configurations Specialist creates and maintains our
internal provider database using the provider information billed
through our claims adjudication system. By verifying the provider
licensing, TAX ID, and address information to ensure the information
we have on file is accurate and matches the IRS and licensing
requirements for accurate claims processing and payment distributions.
This is a data entry position with production-based performance requirements.
- Add/update providers to claims administration system based on
various types of approved documentation.
- Add network contracts and provider types to drive claims benefit
and pricing application when required for claims processing
- Responsible for daily claims and correspondence as assigned.
- Responsible for verifying accuracy of provider addresses and
specialty information in the provider file.
- Works efficiently, perform multi-tasking, prioritize tasks, and
meet tight deadlines.
- Performs other duties as assigned to ensure individual and group
goals are achieved with accuracy, customer service, and timely.