Job Description: Job Profile Summary
Responsible for all duties associated with contract administration including timely, accurate data entry and maintenance of provider records in multiple databases. Researches and resolves questions, complaints, and ensures that information in all databases is accurate and properly configured to support operations. May help train lower level peers.
Job Description
Performs review and analysis of incoming contractual documents for completeness, historical activity, and timely, accurate provider record set-up and data entry.
Communicates extensively with Field Network staff and Provider community regarding contract documentation questions and concerns; obtains missing documents/elements for processing.
Determines appropriate network participation status; investigates accuracy of network affiliations and contract/rate documents to ensure accuracy of reimbursement to providers.
Executes appropriate contractual documents; updates network affiliations in the provider database to reflect participation status, requests correspondence to providers to communicate contract status and effective dates.
Links group members to appropriate group practices. Ensures accuracy of TIN, service addresses, and network affiliation status based upon group network affiliations. Conducts investigations concerning historical associations with previous group practices and individual contracts.
Researches and responds to providers and other internal staff regarding complex inquiries.
Responds to requests to update or change information and ensures that all changes are made within operational guidelines to accurately support all other systems related functions.
Supports the implementation of new business by ensuring providers are appropriately and accurately loaded in all applicable systems.
Supports internal auditing process to ensure data accuracy and integrity.
Ensures all assigned duties are completed within expected timeframes.
Performs other duties and special projects as assigned.
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Last updated on Nov 1, 2023