Senior Specialist, Provider Network Administration - Remote

Overview

The Senior Specialist in Provider Network Administration is responsible for the accurate validation and maintenance of critical provider information on claims and provider databases, ensuring adherence to business and system requirements.

In Short

• Responsible for provider-related data and report generation.
• Ensures compliance with regulatory/accreditation requirements.
• Generates reports for quality improvement of the provider database.
• Maintains documentation and guidelines for assigned responsibilities.
• Requires a Bachelor’s Degree or equivalent experience.
• 3-5 years of managed care experience required.
• Experience with Medical Terminology, CPT, ICD-9 codes.
• Intermediate skills in Access and Excel.
• Preferred experience includes QNXT, SQL, and Crystal Reports.
• Offers competitive benefits and compensation.

Requirements

• Bachelor's Degree or equivalent combination of education and experience.
• 3-5 years managed care experience.
• 2+ years in Provider Claims and/or Provider Network Administration.
• 3+ years’ experience in Medical Terminology, CPT, ICD-9 codes.
• Intermediate skill level in Access and Excel.

Benefits

• Competitive benefits and compensation package.
• Equal Opportunity Employer (EOE).