Human Resources Assistant
Jafferjee Brothers Exports (Pvt) Ltd
Tabula Rasa HealthCare Group
Job type full-time
Full job description
Claims management - pk- provider network specialist
StLouis, mo, usa virtual req #12
Thursday, march 18, 2021
Our goals are to provide excellent service, utilize advanced technology, and proficiently deliver resultsTo accomplish these goals, we constantly seek individuals who look for ways to do things betterWe are a company whose culture cultivates teamwork, rewards excellence, focuses on quality for every aspect of our business, and promotes community involvement.
Tabula rasa healthcare (trhc) is a leader in providing patient-specific, data-driven technology and solutions that enable healthcare organizations to optimize performance to improve patient outcomes, reduce hospitalizations, lower healthcare costs, and manage riskMedication risk management is trhc’s lead offering, and its cloud-based software applications, including eirenerx® and medwise™, provide solutions for a range of payers, providers and other healthcare organizations.
Trhc empowers our employees to provide excellent service, utilize advanced technology, and proficiently deliver resultsOur 32fundamentals are what we are and who we areOur culture cultivates teamwork, rewards excellence, focuses on quality for every aspect of our business, and promotes community involvementAs a part of our team, you will help us bring innovative service models to healthcare, improving patient outcomes.
Peaktpa provides services that optimize your organization’s financial management and fulfill regulatory requirements for health plan functionsOur expertise in health plan management, particularly in pace, means you can focus on delivering high-quality care to your participants.
Summary: under the supervision of the provider network supervisor, the provider network specialist is responsible for creating provider records in the claims processing system and linking records to the appropriate fee scheduleThis position is also responsible for analyzing and interpreting provider contracts to ensure accurate reimbursement.
Essential functions: creates provider and vendor records in claims processing system builds and maintains fee schedules based on submitted provider contracts assigns fee schedules to appropriate provider and vendor records effectively analyzes and interprets provider contracts manages pended claims that require additional contractual review
Additional functions: assists with special projects, as requested communicates clearly and concisely, with sensitivity to the needs of others maintains the confidentiality of all company procedures, results, and information about participants, clients, providers and employees maintains courteous, helpful and professional behavior on the job establishes and maintains effective working relationships with co-workers ensures customer satisfaction by understanding and applying the customer service policy, procedure and standards follows all policies and procedures and hipaa regulations maintains a safe working environment
Supervisory responsibility: none
Travel: minimal travel, less than 10%, expected for this position
Knowledge, skills and abilities: educational requirements include a high school diploma or equivalentThree years of professional work experience in a health plan management setting is preferred knowledge of provider contracts, fee schedules and payment methodologies knowledge of medical terminology knowledge of medical claims processing knowledge and experience using current computer technology, and a strong knowledge of excel and microsoft wordSkilled in establishing and maintaining effective working relationships with clients, and staff at all levels skilled in data analysis and problem solving using defined methodologies skilled in problem resolution; recommends suggestions to increase accuracy and/or efficiency ability to work independently with minimal supervision ability to have superior attendance to fulfill all position functions ability to independently follow through on projects ability to communicate professionally, clearly and effectively, verbally and in writing ability to prioritize effectively ability to consistently multitask
Physical demands & requirements: communicate by way of the telephone with participants, customers, vendors and staff operate a computer and other office productivity machinery, such as a calculator, copy machine, fax machine and office printer remain stationary for extended periods of time occasionally exert up to 20 pounds of force to lift, carry, push, pull or move objects visual acuity to perform activities such as identifying, inputting and analyzing data on a computer terminal and/or in hard copy occasional reaching to retrieve shelved items occasional bending/stooping
Work environment: this job operates in a professional office environment, or home office environment, with a conversational noise levelNo substantial exposure to adverse environmental conditions is expectedModerate pressure to meet scheduled appointments and deadlines potential for occasional verbal aggression by clients and vendors the company is proud to be an equal opportunity employerAll qualified applicants will receive consideration without regard to ancestry or national origin, race or color, religion or creed, age, disability, aids/hiv, gender, marital or family status, pregnancy, childbirth or related medical conditions, genetic information, military service, protected caregiver obligations, sexual orientation, protected financial status or other classification protected by applicable law.