Provider Maintenance Specialist - REMOTE Opportunity!

S&S Health is a premier healthcare administration company located in Cincinnati, Ohio. We offer self, level and fully funded solutions that lower costs while improving outcomes with a consumer centric experience. Our integrated benefits, services and technology platform have been developed to serve the needs of Employers, TPAs, and Health Systems. The company has a nationwide presence with the ability to sell and service in every state.

The Provider Maintenance Specialist is responsible for maintenance and updates of the data integrity of provider information within the adjudication system and supporting data bases generated from various sources. This position is responsible for ensuring provider records are accurately created and maintained and updates are completed within designated turnaround times.

 Essential Functions:

• Create and maintain all provider records within claims adjudication systems and supporting data bases. This includes setup of demographic and specialty information and evaluation of applicable network association.
• Evaluate and complete applicable action associated with data received from multiple networks.
• Evaluate and resolve incoming customer service inquiries.
• Support analyst referrals related to provider updates driven by real-time claim receipt.
• Resolve incoming provider maintenance correspondence according to defined turnaround expectations.
• Support annual IRS defined procedures related to the annual evaluation of “B-Notices”, proposed penalty response and support on 1099 filing.
• Conduct group domestic audits and documents results/findings.
• Maintain provider maintenance manual with documented procedures.
• Support various levels of provider maintenance refinement activities.
• Collaborates with Operations Team on provider maintenance assignments/projects.
• Performs other duties as assigned.

 Minimum Qualifications:

• 1-3 years of experience in healthcare insurance.
• Exceptionally detail oriented.
• Excellent problem-solving abilities.
• Strong oral and written communication skills.
• Strong organization, detailed oriented and time management capabilities.
• Ability to handle work-related stress.
• Ability to represent the department in a professional manner.
• Moderate knowledge of Microsoft applications.
• Advanced knowledge with Microsoft Excel (pivot tables, V & H Lookups)
• A strong sense of process/efficiency and excellent interpersonal /relationship building skills.
• A team player, flexible in the context of change.
• Able to handle confidential information.
• Demonstrated ability in prioritizing and handle multiple projects.
• Strong interpersonal skills.
• Regular and reliable attendance is a requirement of the position.

 EDUCATION/EXPERIENCE 

• High School diploma or GED with experience in medical insurance or managed care.
• Post high school education is preferred.
• 1-3 years’ experience in healthcare in a Provider Relations/Customer Service or Claims environment or an equivalent combination of education, training, or work experience which demonstrates the ability to perform the duties of this position.