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Provider Information Specialist I

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NTT DATA

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Location:
United States , Baton Rouge

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Category:
Customer Service

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Contract Type:
Not provided

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Salary:

Not provided
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Job Description:

Summary: Compile appropriate information to make requested credentialing, contractual, and demographic updates and changes related to provider data in the systems of record in an accurate, complete and timely manner. Manage and sustain positive provider relationships. Setup providers and networks in systems of record, assign provider numbers and communicate with provider community. Facilitate accurate financial claims payment and provider directory processes. Represent BCBSLA to external provider communities and internal stakeholder groups.

Job Responsibility:

  • Accurately setups providers in provider systems of record to ensure appropriate claims payment in accordance with contractual language
  • Compiles, analyzes, and verifies the required information for provider enrollment, contracts, and maintenance for completeness and accuracy, and enter it into the systems of record
  • Communicates, orally and in writing, directly with providers to resolve questions and issues regarding updates and changes in the systems of record
  • Researches, responds to, analyzes and resolves complex claims issues related to provider setup and provider eligibility on a daily basis
  • Creates resolution documents to address provider issues and increase provider satisfaction
  • Utilizes probing and problem solving methods to resolve all inquiries/requests
  • Identifies, understands and anticipates providers unexpressed needs and concerns
  • Provides cross functional support and serves as subject matter resource or second tier resolution to internal and external provider teams (i.e., Contracting, Provider Relations, etc)
  • Manage timely responses to external provider inquiries and requests
  • Evaluate new service requests from providers to determine appropriate actions for recording into the systems of record
  • Recommend, and participate in process improvement opportunities for Network Management Operations
  • Identify system problems, gaps or inconsistencies in workflows and/or processes
  • Recommend appropriate updates, alternatives and solutions
  • Accountable for complying with all laws and regulations associated with duties and responsibilities

Requirements:

  • Two years of customer service, credentialing, enrollment and billing, claims and/or insurance operations experience is required
  • One year experience in of insurance services and operations
  • High School diploma or equivalent is required
  • Prefer an Associate or Bachelor’s degree in business or health related field

Nice to have:

  • Facets, IPD, Provider Manager, and Cactus knowledge preferred
  • Prior claims processing experience preferred
  • Strong analytical skills/problem solving skills
  • Critical thinking/ability to question
  • Provider (customer) focused
  • Interpersonal skills/relationship building
  • Excellent communication skills with internal and external stakeholders
  • ability to effectively communicate with provider community in a professional manner
  • Ability to multitask in a fast-paced production environment
  • Strong organizational skills/Time management
  • Takes accountability for work performed
  • Ability to work both individually and in a team environment with shared goals
  • Ability to work under pressure to produce high quality work with defined turnaround goals
  • Ability to effectively adapt to change

Additional Information:

Job Posted:
April 23, 2026

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