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  • Responsible for accurate and timely maintenance of critical provider information on all claims and provider databases.
  • Maintains critical provider information on all claims and provider databases.
  • Synchronizes data among multiple claims systems and application of business rules as they apply to each database.
  • Validate data to be housed on provider databases and ensure adherence to business and system requirements of customers as it pertains to contracting, network management and credentialing.
  • Audits provider records for quality and financial accuracy prior to system loading and provides documented feedback as necessary.
  • Prepares and in-loads provider fee sets as necessary to facilitate provider and vendor configuration in EzCap.
  • Assists in configuration issues and loading of provider information ,as needed.
  • Validates data prior to entry to ensure accuracy of data to be added to the system.
  • Maintains provider and vendor files in accordance with contracted status and demographic changes.
  • Generates and distributes Network Related Compliance/Regulatory and Accreditation reports.
  • Generate Provider Related reports to facilitate and support Provider Services, Claims, and Utilization management teams, assisting with problem research and resolution.
  • Assists with data preparation and maintenance of Provider Directory information.
  • Must be well-organized and detail orientated. Professional demeanor. Strong customer service
  • Performs other duties as assigned.

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