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Provider Informatics Representative
Network Health is seeking a Provider Informatics Representative who supports and maintains provider data for multiple lines of business (HMO, POS, PPO, Medicare Advantage, Self Funded) in multiple data sources. Extracts provider data for statistical purposes, PPO claims administration, network adequacy analysis, creation of Provider Directories. Processes telephone inquires from internal customers, and external customers (Providers, Employer Groups, Member, PPO Third Party Administrators). Provides excellent service to internal and external customers through demonstrated commitment to Network Health mission and values.
Professionally work with external customers. This includes responsibility for thorough investigation of discrepancies, analyze, problem solve, ensure accuracy of provider data in multiple systems and respond to inquiries accordingly. Ability to complete data entry of provider information into any/all data sources, meeting audit and regulatory requirements.
Efficient in the use of multiple software/systems (e.g. QNXT, Facets, QuickBase, GeoAccess, Directory/Expert, Adobe Acrobat, Microsoft Office Word/Excel/Access). Ability to program/produce/generate/develop/manipulate reports as necessary.
Ability to establish a rapport with a broad spectrum of internal and external customers, maintaining proper voice tone and language in accordance with the caller's level of understanding and to ensure positive customer perception.
Produce, publish, send and track all Network Health Provider directories, printed and online.
Produce, manipulate, send and track data files for all PPO TPA Provider extracts.
Ability to maintain confidentiality as it relates to providers/contracts.
Ability to work as a team member, as well as working with other internal departments, independently demonstrating a high level of initiative and self-direction with limited assistance.
Ability to write and maintain processes/procedure(s) related to provider data.
Performs other duties as assigned.
High school diploma, or equivalent. Associate degree or related experience preferred.
Two or more years experience working in the medical industry preferred
Customer service experience preferred.
At least two years work experience working with data entry, changes and maintenance.
This position is eligible to work remotely in the state of Wisconsin assuming work at home requirements are met.
Time: Full time
Category: Network management
Updated: 6/9/2022 11:17:15 AM