Provider Information Specialist I Job at NTT DATA (Baton Rouge)

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

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Provider Information Specialist I

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