Provider Specialist (Remote)

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Job Summary

This Position Is Responsible For Loading Providers Into The Ihscps System Understanding Center For Medicare Services Reimbursement At A National Level For Inpatient, Outpatient, Professional And Ancillary Services And Being Able To Interpret Indian Health Services Contract Language To Correctly Create The Pricing In The Ihscps System For Each Contract Testing All Projects That Could Impact Or Involve The Pricing Methodologies.

1. Establish, maintain and monitor contract, provider, and pricing files.

2. Contact providers and IHS contract officers to obtain/verify necessary information.

3. Understand billing protocols to maximize the use of automated pricing options.

4. Review contracts for accuracy and completeness of information, contacting contract officers as necessary by phone, email or letter to clarify contractual language or intent and FI pricing options.

5. Calculate manual or special contract pricing and resolving complex pricing pends.

6. Participate in system testing developing test scripts for each pricing application functionality when needed; testing to meet implementation schedules; supporting implementation to production environment, which may require working outside the normal business hours.

7. Write clear, usable and accurate manual pricing instructions.

8. Resolve payment disputes and pricing problems by verifying accurate entry of claim, providers, and contracts, as requested by both external and internal customers.

9. Perform 100% quality review on all new contracts entered.

10. Request and distribute the Contracts in Effect, Contracts to Expire and Provider Contract Monitoring Reports and Vendor List.

11. Issue form letters to Contract Officers and providers with information on contracts, rate quotes or provider agreements.

12. Educate and provide information and/or recommendations to providers and IHS Contract Offices on claims filing, provider file, and contract requirements.

13. Function as subject matter expert (SME) on provider and pricing files for the IHS Operations Units, and train any new provider payment specialist or level 2 provider payment clerk in tasks related to provider, contract, pricing or legal entity files.

14. Assist with claims processing and adjustments as needed.

15. Communicate and interact effectively and professionally with co-workers, management, customers, etc.

16. Comply with HIPAA, Diversity Principles, Corporate Integrity, Compliance Program policies and other applicable corporate and departmental policies.

17. Maintain complete confidentiality of company business.

18. Maintain communication with management regarding development within areas of assigned responsibilities and perform special projects as required or requested.

• Preference in filling vacancies is given to qualified Indian candidates in accordance with the Indian Preference Act of 1934 (title 25, USC Section 472)

Native American Indian Preference shall apply to this position pursuant to the Indian Self-Determination and Education Assistance Act (24 U.S.C. 450, et seq.), 25 CFR 271.44 and other relevant laws (title 25, U.S. code, Section 472 & 473)*

JOB REQUIREMENTS:

• High school diploma or equivalent.
• Two years medical claims processing experience, including coordination of benefits, adjustments, and provider payment.
• Knowledge of medical terminology, ICD-10, CPT-4, HCPCS and dental coding, and claim forms.
• Ability to handle multiple projects and to meet strict deadlines
• Ability to work independently.
• Analytical and research skills.
• Verbal and written communication skills.
• Math skills.

PREFERRED JOB REQUIREMENTS:

• Knowledge of the IHSCPS provider, contract pricing and claims processing system.
• Knowledge of Medicare pricing methodologies and other provider reimbursement methods
• Interpreting and Entering Provider Contracts experience
• Team skills, including the ability to work with others or work independently as warranted by the task.
• Professional, courteous and active listening skills when using the telephone.
• Knowledge of coordination of benefits (COB) principles and terminology; ability to determine health care reimbursement methodologies and coordinate benefits.
• Knowledge of PC and various software programs preferred.

Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!

Pay Transparency Statement:

At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting https://careers.hcsc.com/totalrewards.

The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan.

HCSC Employment Statement:

We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.

Base Pay Range

$17.75 - $28.39

Exact compensation may vary based on skills, experience, and location.