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Provider Database Coordinator

Irvine, CA 92618

Job Function: Administrative, Healthcare - Other Job Number: 402893

Job Description

Johnson Service Group (JSG) is seeking Healthcare Provider Database Coordinators with claims processing experience.
Pacific Standard Time Zone 
Days/hours:  Monday-Friday- 8:00am-5:00pm
Hourly wage: $20.00-$22.00 per hour
This position is fully remote

QUALIFICATIONS
• High school education or equivalent and two (2) plus years of healthcare coding/billing and/or provider credentialing/eligibility experience.
• Excellent data entry skills with outstanding manual dexterity.
• Strong phone and verbal communication skills.
• Proficient in Microsoft Office (Word, Excel, Outlook).
• Basic ability to navigate basic computer systems and website applications.
• Healthcare knowledge as it relates to provider billing practices for medical and dental.
• Knowledge of medical terminology, claim fields, and the basics of HMO, PPO, EPO, POS, Self-Funded, Large plan products, and State/Federal payers Medicare & Medicaid.
• Basic knowledge of Medicare Fee Schedule and the design, CPT/HCPS service coding, understanding the provider types and their impact on claims and reimbursements.
• Basic understanding of participating and non-participating policies and contracting information.
• Experience in Provider credentialing & enrollment– National Provider Identifier (NPI) database and what information is provided.

DUTIES AND RESPONSIBILITIES
Data Entry and Database Maintenance
• Load accurate provider information into HCPS as indicated on the medical/dental claim form.
• Review and research provider medical and dental claims for complete and accurate information, including address, phone number, license number and Federal Tax ID numbers.
• Maintain the non-Anthem eligible plans on all Anthem providers.
• Load Preferred Provider Organization (PPO) network from all third-party vendors as applicable to the appropriate health benefit plan.
• Utilize pricing guidelines, support the claim pricing processes and apply based on participating or non-participating providers.
• Create provider files utilizing knowledge of provider types, and department/regulatory codes for proper use of the maintenance files.
• Maintain interactions with various provider network system for contracting and claim support.
• Assist in the review and maintenance of the Anthem weekly provider updates utilizing reports available.
• Assist in the maintenance and resolution of Internal Revenue Service (IRS) requests, IRS 1099 form issues and levies. Assists in the review of the IRS 1099 form edit report at year-end for discrepancies.
• Maintain W-9 forms on file for all providers.
Customer Service
• Manage all provider maintenance requests and forward completed work back to appropriate department.
• Research Anthem and any other third-party PPO network to resolve any provider contract issues involving participating and non-participating status as well as any pricing area issues.
Other
• Maintain a Health Insurance Portability and Accountability (HIPAA) compliant workstation and utilize appropriate security techniques to ensure HIPAA required protection of all confidential/protected client and enrollee data.
• Utilize all capabilities to satisfy one mission — to enhance the competitiveness and profitability of our members. Do everything possible to help members succeed by being curious and striving to understand what others are trying to achieve, planning, and executing work helpfully and collaboratively. Be willing to adjust efforts to ensure that work and attitude are helpful to others, being self-accountable, creating a positive impact, and being diligent in delivering results.
• All other duties as assigned.

** Johnson Service Group (JSG) is an Equal Opportunity Employer. JSG provides equal employment opportunities to all applicants and employees without regard to race, color, religion, sex, age, sexual orientation, gender identity, national origin, disability, marital status, protected veteran status, or any other characteristic protected by law.
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