Job Information
DOCTORS HEALTHCARE PLANS, INC. Provider Data Maintenance Coordinator in Coral Gables, Florida
Position Purpose: Process claims in the Zero Queue and maintenance of provider contracts.
Responsibilities:
Process claims in the Zero Queue
Research Non-Par providers in external platforms
Maintain Non-Par providers in the system
Assist in the loading of Participating provider rosters or sites as needed
Maintain provider rosters
Maintain Provider Directory data
Analysis and resolution of tickets coming from the Claims and Provider Relations Departments
Meet performance goals as established for the position
Performs additional duties and responsibilities as assigned by management
Qualifications:
Experience in Medicare Advantage operational and regulatory guidelines
Knowledge of provider contracts and reimbursement methodologies
Understanding of claims processing and medical terminology is desirable
Excellent organizational and communication skills
Strong analytical and critical thinking skills
Experience working in a team-oriented, collaborative environment
Computer literacy: MS Excel, MS Word, etc.
Note: This description indicates, in general terms, the type and level of work performed and responsibilities held by the team member(s). Duties described are not to be interpreted as being all-inclusive or specific to any individual team member.
No Third Party Agencies or Submissions Will Be Accepted.
Our company is committed to creating a diverse environment. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status. DFWP
Opportunities posted here do not create any implied or express employment contract between you and our company / our clients and can be changed at our discretion and / or the discretion of our clients. Any and all information may change without notice. We reserve the right to solely determine applicant suitability. By your submission you agree to all terms herein.
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