Associate Provider File Representative

Highmark Health

114d • $19 - $26

About The Position

This job 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.

Requirements

• High School Diploma or GED.
• One year of experience in Provider Data Management, Credentialing, Customer Services or Claims.

Responsibilities

• Maintain accurate data in provider file data systems.
• Common transactions include: Maintaining and initial setup of assignment accounts (AA) from the AA applications, Updating 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 requests.
• Ensure 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 numbers, National Provider Identifier (NPI), CMS required provider identifiers for compliance with corporate and federal contracts.
• Educate providers for obtaining and updating provider identifiers.
• Other duties as assigned or requested.

What This Job Offers

• Education Level: High school or GED
• Number of Employees: 5,001-10,000 employees