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Provider File Data Researcher

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The Opportunity

We are looking for a Provider File Data Researcher, working in the Insurance industry in DeWitt, New York, United States.

  • Researches, responds to, and resolves all issues related to Provider Databases to ensure data is accurate, consistent and configured to guarantee accurate claims processing and provider reimbursement-
  • Performs multiple system transactions relative to maintaining the Provider Information Databases including claims and credentialing systems
  • Executes the appropriate provider database transaction to resolve provider related claim suspends
  • Resolves insurance discrepancies by researching provider data attributes to identify correct provider selection.
  • Researches and analyzes provider data to ensure it enforces corporate policy as it relates to system maintenance of Provider Network affiliations and reimbursement methodology through use of knowledge of Health Care Products/Programs, Provider Network arrangements, Provider Reimbursement agreements, and Provider Contractual agreements.
Details

The pay range we are offering is 11 to 13 per hour. This position may present an opportunity to go permanent.

Our Client

Our client is a fast-growing industry-recognized staffing firm.  Recruiting critical IT, Financial, Engineering, Healthcare, and Data Analytics talent.  With 20+ years’ experience and growth. 

Connections in Automotive, Healthcare, Retail, Financial & Insurance, and Professional & Business Services.  Working to bring top talent together with premier organizations.

Big enough to have great opportunities.  Small enough to care about finding the right one for you. 

It’s about relationships based on mutual interest.  The results are low turnover, long-lasting partnerships and growth.  Want to work for a company invested in your success?

Experience Required for Your Success
  • Bachelor degree in Business Administration or related field preferred.
  • Minimum of 1 year experience working with physicians, claims, provider contracting or provider database environment.
  • Preferred experience with the Provider Sub-systems in TOPS/TOPPS, CAPS, UWIN, ICPS, PMA, FACETS, ERISCO.
  • Strong analytical, problem solving, troubleshooting and organizational skills essential.
  • Must be PC savvy with knowledge of Excel, Access and other software tools.
  • Demonstrates a basic understanding of provider data and healthcare insurance.
  • Must be well organized and self-motivated and possess ability to prioritize requests to meet timeframes.
What Do You Think?

Does your experience reflect what it takes to be successful in this role? Do the work and challenges get you excited about what's possible? Apply here.

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