Provider Systems Data Specialist Ii
Current- Review and process provider data forms into claim systems, such as Amysis, to drive the reimbursement of their submitted claims.- Review and resolve electronic claims that cannot be processed automatically for a variety of reasons. - Communicate, via email and telephone, with contracted and non-contracted providers to ensure accurate information on themselves and their practices in order to distribute access to the patients.- Respond to telephone inquiries using an ACD telephone system.- Creates, analyzes, and uses documents in Microsoft Word and Excel. - Generate Business Object Reports to dissect the amount of denied/paid claims, their reasons, and the timeline of payments or denials.- Set up new contracted and non-contracted providers in our databases, including information like Tax ID numbers, NPIs, site and remittance addresses, phone and fax numbers, license and DEA numbers, and pay class codes.- Understands and uses a variety of codes that relate to the claims payment system to ensure accurate payment amounts depending on various bases like, contract terms, location, provider specialty type, services rendered, etc. - Review credentialing profiles to begin set-up in the database. - Interact with colleagues for support and engagement in larger group project settings.- Process change requests submitted by providers about their personal or practice information.
