WI3667484

1

Master's Degree

Masters Degree

Unspecified

40

JOB REQUIREMENTS: Provider Enrollment Analyst Job Locations US-WI ID
2024-2088 Category Provider Relations Type Regular Full-Time Overview
Quartz is thrilled to offer opportunities for professional growth in our
Provider Enrollment Department. The Provider Enrollment Analyst will
build and maintains Practice Locations, Facilities, Practitioners and
Contracts in both the Provider Database and the company\'s claim
processing system. This position will maintain accuracy and timely data
entry including quarterly verification of provider data in compliance
with the No Surprise Act and NCQA guidelines. Benefits: Supportive team
environment with strong relationships & bond Ability to make a positive
impact in a quickly growing, faced paced organization Excellent
mentoring, learning and growth opportunities Based compensation range:
\$51,000 - \$63,000 Responsibilities Build and maintain provider and
facility records including adds, changes and terminations within the
claims adjudication system (HealthLink). Sets up and maintains provider
(SER), facility (FAC), place of service (POS), PCP Location (LOC), PCP
status, and network records for adds, changes and terminations for
contracted providers. Processes updates to vendor (VEN) records, 835 and
EFT builds, and add claim alerts when needed. Preps and loads provider
information into HealthLink through an import spreadsheet and direct
entry and maintenance in HealthLink. Builds and maintains Practice
Locations, Facilities, Practitioners and Contracts in the Provider
Database (eVIPs). Sets up and maintains Contracts, Facilities, Practice
Locations, Practitioners, and networks. for adds, changes and
terminations for contracted entities. Enters and maintains providers,
practitioners, and facilities while linking them to the contracts and
networks including prepping and loading data manually, through dynamic
import utility, through BOT automation, and mass update and mass insert
processes. Configures and maintains Data Masters, Reference tables,
Networks and Address Masters. Performs provider licensure, NPI, Medicare
and Medicaid validation. Performs departmental and corporate project
work and other duties as assigned by Manager. Conducts query requests
and runs ad-hoc reports as needed. Submits Provider and Facility rosters
for self-funded business. Conducts research based on claims received,
communication from the providers, and source verification documentation
for responding to CRMs, providers, and claims inquiries. Qualifications
2+ years of health claims process or provider data experience Familiar
with health insurance or healthcare industry; medical billing experience
preferred Experience with Microsoft products; proficient in MS Excel and
Word Epic and/or eVIPs knowledge is desirable Strong analytical
skills\... For full info follow application link. Equal Opportunity
Employer of Minorities, Females, Protected Veterans, and Individual with
Disabilities \*\*\*\*\* APPLICATION INSTRUCTIONS: Apply Online:
ipc.us/t/A6698E3701D343C3