Address
Form of work Responsibilities
Job Summary: The Provider Data Management Resolution Analyst acts as a liaison between providers and the organization in both the claims and credentialing areas. This role assists with escalated provider issues through providing research and follow up to involved parties. Position evaluates all presented applicant information for initial and re-credentialing, directing, and overseeing primary source verification, and ensuring clarification of any discrepancies discovered in the verification process. Position accurately summarizes and reports the results of each investigation to the Medical Director and Plan Credentialing Committee, with written follow-up regarding credentialing determinations, as required. Position also ensures processes demonstrate compliance with State, Federal and National regulatory requirements, and the accreditation standards of the National Committee for Quality Assurance (NCQA) and Medicare (CMS). Position supports all aspects of Provider Data management to ensure the providers data is accurately captured in the claims processing system.
Qualifications
Qualifications and Requirements:
EEO Statement
All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.
We believe that diversity and inclusion among our teammates is critical to our success.
Notice
At UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skillset and experience with the best possible career path at UHS and our subsidiaries. We take pride in creating a highly efficient and best in class candidate experience. During the recruitment process, no recruiter or employee will request financial or personal information (Social Security Number, credit card or bank information, etc.) from you via email. The recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc. If you are suspicious of a job posting or job-related email mentioning UHS or its subsidiaries, let us know by contacting us at: https://uhs.alertline.com or 1-800-852-3449.
Job Summary: The Provider Data Management Resolution Analyst acts as a liaison between providers and the organization in both the claims and credentialing areas. This role assists with escalated provider issues through providing research and follow up to involved parties. Position evaluates all presented applicant information for initial and re-credentialing, directing, and overseeing primary source verification, and ensuring clarification of any discrepancies discovered in the verification process. Position accurately summarizes and reports the results of each investigation to the Medical Director and Plan Credentialing Committee, with written follow-up regarding credentialing determinations, as required. Position also ensures processes demonstrate compliance with State, Federal and National regulatory requirements, and the accreditation standards of the National Committee for Quality Assurance (NCQA) and Medicare (CMS). Position supports all aspects of Provider Data management to ensure the providers data is accurately captured in the claims processing system.
Qualifications
Qualifications and Requirements:
- High school diploma: Associates degree or equivalent work experience preferred
- Minimum of 6 months experience in working with Provider Data and credentialing functions
- 3 years customer service with ability to handle challenging customer situations in a professional manner.
- Knowledge of QNXT claims processing system
- Knowledge of Provider and Credentialing terminology
- Ability to interpret health plan benefits and provider contracts.
- Excellent computer skills which must include proficiency in Microsoft Office Suite with emphasis on Excel and Power Point.
- Excellent English communication skills with an ability to communicate complex program criteria into easily understood summaries both orally and written
- Proficient critical-thinking and analytical problem-solving skills
- Identify, recommend, and implement processes that improve quality, increases productivity, reduces waste, costs, and rework resulting in business improvement and customer satisfaction.
- Ability to interpret and apply established policies and procedures.
- Must be a team player and ability to work independently with little supervision
EEO Statement
All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.
We believe that diversity and inclusion among our teammates is critical to our success.
Notice
At UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skillset and experience with the best possible career path at UHS and our subsidiaries. We take pride in creating a highly efficient and best in class candidate experience. During the recruitment process, no recruiter or employee will request financial or personal information (Social Security Number, credit card or bank information, etc.) from you via email. The recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc. If you are suspicious of a job posting or job-related email mentioning UHS or its subsidiaries, let us know by contacting us at: https://uhs.alertline.com or 1-800-852-3449.
