JOB SUMMARY
The incumbent supports provider account support activities with the implementation and administration of provider demographic information, credentialing and credentialing compliance. This position identifies and resolves problems related to provider file set up, provider affiliations, reporting, data inputs and outputs and any subsequent requirements. The incumbent may have direct interaction with providers, provider offices, billing agents, provider representatives, management and internal staff. The position ensures compliance with National Committee on Quality Assurance (NCQA), CMS, DOH regulations, BCBS, internal and private business audits in the provider data management space. The incumbent is responsible for contract administration – inclusive of, but not limited to, contract generation, reviewing signed contracts, updating provider file and executing contract.
ESSENTIAL RESPONSIBILITIES
EDUCATION
Required
High School Diploma/GEDSubstitutions
NonePreferred
Bachelor's DegreeEXPERIENCE
Required
3 years in a service role, in any industry involving customer support or related fieldPreferred
1 year of Operations Support1 year in Customer Service1 year with Provider Credentialing1 year in Provider ServiceLICENCES OR CERTIFICATIONS
Required
NonePreferred
NoneSKILLS
Oral and Written Communication SkillsDigital SkillsTeamworkCompany CultureCritical ThinkingProblem SolvingDecision MakingAnalytical SkillsUnderstands fundamental principles, concepts, practices and processes within a specific field or disciplineThis individual must possess a high accuracy level while applying complex and detailed guideline to multiple increments of work.Proficient in PC skills, word processing software, accessing the internet, web based applications and manage files.Multi-TaskingLanguage (Other than English):
None
Travel Requirement:
0% - 25%
PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS
Position Type
Office-based
Teaches / trains others regularly
Occasionally
Travel regularly from the office to various work sites or from site-to-site
Rarely
Works primarily out-of-the office selling products/services (sales employees)
Never
Physical work site required
Yes
Lifting: up to 10 pounds
Constantly
Lifting: 10 to 25 pounds
Occasionally
Lifting: 25 to 50 pounds
Occasionally
Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.
Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
EEO is The Law
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