Provider File Maintenance (PFM) Specialist
Location: Birmingham, AL
Work Schedule: Mostly Remote - after an onsite training period at our downtown Birmingham office, this position can transition to work mostly remote, with occasional onsite days. The successful candidate must reside within a reasonable travel distance of Birmingham.
Why VIVA HEALTH?
VIVA HEALTH, part of the renowned University of Alabama at Birmingham (UAB) Health System, is a health maintenance organization providing quality, accessible health care. Our employees are a part of the communities they serve and proudly partner with members on their healthcare journeys.
VIVA HEALTH has been recognized by Centers for Medicare & Medicaid Services (CMS) as a high-performing health plan and has been repeatedly ranked as one of the nation's Best Places to Work by Modern Healthcare.
Benefits
- Comprehensive Health, Vision, and Dental Coverage
- 401(k) Savings Plan with company match and immediate vesting
- Paid Time Off (PTO)
- 9 Paid Holidays annually plus a Floating Holiday to use as you choose
- Tuition Assistance
- Flexible Spending Accounts
- Healthcare Reimbursement Account
- Paid Parental Leave
- Community Service Time Off
- Life Insurance and Disability Coverage
- Employee Wellness Program
- Training and Development Programs to develop new skills and reach career goals
- Employee Assistance Program
See more about the benefits of working at Viva Health - https://www.vivahealth.com/careers/benefits
Job Description
The Provider File Maintenance (PFM) Specialist is responsible for maintaining accurate provider demographic, payment, and contractual information in VIVA HEALTH’S claims processing system.
Key Responsibilities
- Enter and update providers in VIVA HEALTH’S claims processing system.
- Verify integrity of data by comparing it to source documents. Review input data for errors or missing information and resolves any discrepancies.
- Monitor and maintain Medicare opted-out providers and Medicare precluded providers.
- Communicate terminated and reinstated providers to all areas of VIVA HEALTH.
- Perform fee schedule maintenance in the claims processing system. Support the configuration team, as needed, in maintaining system reference files.
REQUIRED QUALIFICATIONS:
- High School Diploma or GED
- Healthcare industry knowledge
- Ability to work under pressure to meet deadlines with minimal supervision
- Demonstrate excellent customer service skills through written and verbal communication
- Ability to produce quality-focused work
- Ability to work independently and as a member of a team
- Basic computer skills
PREFERRED QUALIFICATIONS:
- Some College
- Claims processing and/or provider credentialing/contracting knowledge
- 2 – 3 years’ experience with PowerSTEPP
- Proficient knowledge of Microsoft Excel and Microsoft Outlook