Job type temporary
Full job description
Medcost excels at helping our clients lower their health plan costs so they can provide more affordable benefitsThis success is driven by enthusiastic, customer-focused employees — people who seek innovative solutions and are passionate about delivering exceptional resultsThat’s why we are committed to investing in our workforce and fostering a thriving professional cultureWhen you join us, you’ll enjoy a positive work environment built on appreciation and flexibility, opportunities to grow personally and professionally, and competitive pay and benefitsWe invite you to advance your career with medcost and contribute to the growth and success of our company.
Provider maintenance specialist position summary: the provider maintenance specialist is responsible for maintenance and updates of the data integrity of provider information within the adjudication system and supporting data bases generated from various sourcesThis position is responsible for ensuring provider records are accurately created and maintained and updates are completed within designated turnaround timesPosition responsibilities:
Create and maintain all provider records within claims adjudication systems and supporting data basesThis includes setup of demographic and specialty information and evaluation of applicable network association.
Evaluate and complete applicable action associated with data received from multiple networks.
Evaluate and resolve incoming customer service inquiries.
Support analyst referrals related to provider updates driven by real-time claim receipt.
Resolve incoming provider maintenance correspondence according to defined turnaround expectations.
Support annual irs defined procedures related to the annual evaluation of “b-notices”, proposed penalty response and support on 1099 filing.
Conduct group domestic audits and documents results/findings.
Maintain provider maintenance manual with documented procedures.
Support various levels of provider maintenance refinement activities.
Collaborates with operations team on provider maintenance assignments/projects.
Performs other duties as assigned.
Position qualifications: required
High school diploma or equivalent
Working knowledge of microsoft office
Knowledge of third party healthcare operations
Skills, knowledge and abilities
Exceptional quality and attention to detail.
Strong research skills, follow-up skill, documentation skills and issue resolution skills.
Ability to multi-task.
Ability to think independently with strong problem-solving skills with a service oriented attitude.
Excellent oral and written communication skills.
Ability to function as a team player and provide assistance to management and other mbs staff as required
Initiative to learn third party administration concepts and philosophies
Access to protected health information (phi) this position requires the employee to handle phi for duties related to enrollment and eligibility issuesAccess to the phi includes the mbs claim system, eligibility files and any other source necessary to complete client enrollmentPolicies and procedures will be strictly adhered to make sure phi is protected as required by the hipaa privacy rulePrivacy and security responsibilities: responsible and accountable for maintaining the confidentiality, integrity, and availability of protected health informationFollow hipaa security policies and procedures affecting your job and report any suspected or actual violation or breach.
Essential physical functions:
This role routinely uses standard office equipmentWhile performing the duties of this position, the employee is occasionally required to stand; walk; sit, push, pull; use hands to finger, handle, or feel objects, tools or controls, reach with hands and arms; climb stairs; talk and/or hearThe employee must occasionally lift or move office products and supplies, up to 20 poundsReasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Medcost provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local lawsThis policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.
Medcost participates in the electronic verification system (e-verify) to electronically verify the work authorization of newly-hired employeesE-verify is an internet-based program that compares information from an employee`s form i-9 to data contained in the federal records of the social security administration and the department of homeland security to confirm employment eligibilityMedcost does not use e-verify to pre-screen job applicants.