Job Description:
The incumbent is responsible for researching and maintaining provider files on the company's Health Claims Processing System (HCPS) for generation of remittance advice, Explanation of Payment (EOP) and Internal Revenue 1099 forms.
QUALIFICATIONS
• High school education or equivalent and two (2) plus years of healthcare coding/billing and/or provider credentialing/eligibility experience or claims processing experience.
• Excellent data entry skills with outstanding manual dexterity.
• 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.
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.
• Utilize pricing guidelines, support the claim pricing processes and apply based on participating or nonparticipating 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 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.
Customer Service
• Manage all provider maintenance requests and forward completed work back to appropriate department.
• Research 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.
And 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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