Provider Services Specialist

Baton Rouge, LA 70801 | Temporary

Post Date: 04/12/2018 Job ID: 00004MD9 Industry: Clerical Pay Rate: 0.00
Spherion is searching for an experienced Provider Services Specialist. Ideal Candidates: Will have experience with billing credentialing, verifying physicians licensures ability to pull backgrounds and experience setting up providers. Understanding of W9's and CPT Codes. Strong data entry and customer service skills.

Handles complex provider file, provider contracts and credentialing cases in the unit that require special expertise. Maintains provider reimbursement data in the claims database system to ensure the system is setup for proper claims adjudication.

Position Location:
This position reports to the Manager of Networks Configuration, Integration and Analytics.

Activities of Direct Reports: This position has no reports.

Necessary Contacts:
In order to effectively fulfill this position the incumbent must be in contact with:
All departments including Network Administration, Benefits Administration, Legal, IT, Marketing, Provider Reimbursement, Membership and Billing, Operational Training, Corporate Communications, Physicians Office Personnel and other employees as needed. Blue Cross Blue Shield Association, industry contacts, state agencies, such as DOI and business consultants.


High school diploma or equivalent is required.
Four years of experience with Facets system setup, maintenance as it pertains to provider data required.
Two years of experience with provider relations and Network Administration is required. Experience can run concurrently.
1 year provider manager system experience required.
Reimbursement loading, network setup experience preferred.
Medicare Advantage experience as it pertains to provider reimbursement preferred.
Knowledge and understanding of all product lines, provider networks and overall company procedures is preferred.
Proficiency Microsoft Office required.
Excellent organizational and communication skills are required.
Ability to produce quality, timely results while handling multiple projects.
Must be able to work independently and make appropriate and timely decisions.

Receives provider applications, agreements and various updates, verifies accuracy and conducts research in order to setup and maintain provider file reimbursement and network participation of providers. Establishes and maintains accurate provider records in the claims database systems to allow for comprehensive reporting capabilities and appropriate claims adjudication.

Coordinates and completes Unit projects as assigned by Provider Support and Network Operations management to ensure the provider database systems have accurate data.

Coordinates with Accounting and EDI as necessary to resolve complex EFT issues to ensure provider payments are made accurately, timely and to the appropriate provider.

Participates in load testing data in the claims database as requested by Network Operations management, Reimbursement Department, BET and IT by updating, changing and deleting data to ensure processes work as intended prior to implementing programming changes into production.

Serves as back-up on toll free phone line as often as necessary and as assigned management which includes but is not limited to answering calls from the Unit toll-free phone line regarding general provider file record setup information, network participation status, credentialing status and more to educate callers on our procedures and answer their various questions.

Job duties are performed in a normal and clean office environment with normal noise levels.

Work is predominately done while standing or sitting.

The ability to read, write, calculate, visualize, and analyze are required.

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