0 suggestions are available, use up and down arrow to navigate them
What job do you want?

Senior Provider Information Management Representative job in Jefferson City at Highmark Health

Create Job Alert.

Get similar jobs sent to your email

List of Jobs

Apply to this job.
Think you're the perfect candidate?
Senior Provider Information Management Representative at Highmark Health

Senior Provider Information Management Representative

Highmark Health Jefferson City, MO (On Site) Full-Time
**Company :**

Highmark Inc.

**Job Description :**


The incumbent supports provider account support activities with the implementation and administration of provider demographic information, credentialing and credentialing compliance. This position identifies and resolves problems related to provider file set up, provider affiliations, reporting, data inputs and outputs and any subsequent requirements. The incumbent may have direct interaction with providers, provider offices, billing agents, provider representatives, management and internal staff. The position ensures compliance with National Committee on Quality Assurance (NCQA), CMS, DOH regulations, BCBS, internal and private business audits in the provider data management space. The incumbent is responsible for contract administration - inclusive of, but not limited to, contract generation, reviewing signed contracts, updating provider file and executing contract.


+ Load and maintain provider demographic information and credentialing files, as well as load and maintain provider primary source verification information in HC3, the credentialing, contracting and communication system.

+ Responsible to review contracts, as applicable, to ensure there are no changes, secure and execute standard provider contracts, materials, and information as required for the development of provider networks. Maintain credentialing compliance, also handling all error management and ensure files are corrected. Ensure compliance with terms of the provider contracts, file maintenance and credentialing guidelines. Ensure compliance with the following agencies, Federal Government, NCQA and CMS standards are met, American Healthcare Commissions URAC standards within the scope of West Virginia (WV), Delaware (DE), Pennsylvania (PA) and New York (NY) contracts. Department of Labor (DOL), Department of Health (DOH) and/or the Insurance Department. Other agencies include, HIPAA, DMMA, HEDIS, BCBSA and Highmark Health Services and all its affiliates' operational and Corporate policies.

+ Provide support and input in system testing, User Acceptance Testing, business requirements, and test cases.Mentor peers and PIM representatives at all levels.Assist management in root cause analysis.Present at staff meetings.

+ Interact with all levels of management to analyze provider file issues, network status, claims, directory.Prioritize and reprioritize work based on current priorities.

+ Resolve inquiries and provide quality interactions with providers and internal and external entities/organizations to ensure all telephone or written inquiries received are handled promptly, accurately and consistent with department standards and in compliance with all regulating bodies/agencies, documenting information accurately using internal inquiry tracking systems or credentialing database.This position will display communications with varied sources which are not limited to, provider offices, billing agents, provider representatives, management and internal staff.

+ Contact external sources to collect or clarify information or documentation which in turn must be reviewed and evaluated against the established guidelines, policies and procedures to ensure the file meets all policy and procedures in conjunctions with regulations. This specialist must ensure the data in CPR and HC3 are accurate and system compatible.

+ Analyze corrective updates from various quality control reports to ensure provider data accurately reflects current data. Follow guidelines in support of BCBS requirements and maintain strict confidentiality of all information, which requires the integrity and proper handling of all confidential materials.

+ Other duties as assigned or requested.



+ High School Diploma/GED


+ None


+ Bachelor's Degree



+ 5 years in a service role, in any industry involving customer support or related field


+ 3 years of Operations Support

+ 3 years in Customer Service

+ 3 years with Provider Credentialing

+ 3 years in Provider Service



+ Oral and Written Communication Skills

+ Digital Skills

+ Teamwork

+ Company Culture

+ Critical Thinking

+ Problem Solving

+ Decision Making

+ Analytical Skills

+ Understands fundamental principles, concepts, practices and processes within a specific field or discipline

+ This individual must possess a high accuracy level while applying complex and detailed guideline to multiple increments of work.

+ Proficient in PC skills, word processing software, accessing the internet, web based applications and manage files.

+ Multi-Tasking

**Language (Other than English):**


**Travel Requirement:**

0% - 25%


**Position Type**


Teaches / trains others regularly


Travel regularly from the office to various work sites or from site-to-site


Works primarily out-of-the office selling products/services (sales employees)


Physical work site required


Lifting: up to 10 pounds


Lifting: 10 to 25 pounds


Lifting: 25 to 50 pounds


**_Disclaimer:_** _The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job._

**_Compliance Requirement_** _: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies._

_As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy._

_Furthermore, it is every employee's responsibility to comply with the company's Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements._

**Pay Range Minimum:**


**Pay Range Maximum:**


_Base pay is determined by a variety of factors including a candidate's qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets._

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.

EEO is The Law

Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled/Sexual Orientation/Gender Identity ( _[ Link removed ] - Click here to apply to Senior Provider Information Management Representative )

We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact number below.

For accommodation requests, please contact HR Services Online at [ Email address blocked ] - Click here to apply to Senior Provider Information Management Representative

California Consumer Privacy Act Employees, Contractors, and Applicants Notice

Req ID: J218857

Recommended Skills

  • Acceptance Testing
  • Administration
  • Analytical
  • Auditing
  • Billing
  • Business Requirements
Apply to this job.
Think you're the perfect candidate?

Help us improve CareerBuilder by providing feedback about this job:

Job ID: 2424297713

CareerBuilder TIP

For your privacy and protection, when applying to a job online, never give your social security number to a prospective employer, provide credit card or bank account information, or perform any sort of monetary transaction. Learn more.

By applying to a job using CareerBuilder you are agreeing to comply with and be subject to the CareerBuilder Terms and Conditions for use of our website. To use our website, you must agree with the Terms and Conditions and both meet and comply with their provisions.