Provider File Specialist

The challenges of affordable healthcare continue to create new opportunities. Elderplan and HomeFirst, our Medicare and Medicaid managed care health plans, are outstanding examples of how we are expanding services in response to our patients' and members' needs. These high-quality healthcare plans are designed to help keep people independent and living life on their own terms.

Handle all provider file update requests from participating providers, in accordance with the established timeline while developing and maintaining positive provider/customer services. The Provider File Specialist coordinates with various Elderplan Departments to ensure provider file update requests and demographic updates related to claim-denial inquiries are handled appropriately to facilitate the processing/reprocessing of these claims. They organize and submit correspondence from non-par providers for the Provider Data Maintenance Team (PDM) to process accordingly.

High School diploma. Bachelor's degree, preferred.
With Bachelor's degree; minimum of one year of experience in Managed Care, provider billing, and/or customer service.
Without Bachelor's degree, minimum of three (3) years of experience, as above.
Strong Microsoft Excel and data entry skills; ability to type approx. 45wpm.
Strong communication and interpersonal skills.
Minimum of 3 years of experience working in Elderplan's Network Planning of Operations and experience with Cactus and HR Payor, highly preferred.