Randstad claims specialist in Tampa, Florida

claims specialist

job details:

  • location:Tampa, FL

  • salary:$17 per hour

  • date posted:Wednesday, November 14, 2018

  • experience:2 Years

  • job type:Contract

  • industry:Health Care and Social Assistance

  • reference:445847

job description

claims specialist

job summary:

JOB SUMMARY

Coordinates and controls the workflow occurring in and out of the department

Tracks and reviews contracts and credentialing information within the unit

Coordinates with other functional departments as required.

ESSENTIAL FUNCTIONS

Liaison between all cross functional partners to communicate and resolve issues that arise between the departments

Tracks different types of requests coming into the department

Quality check integrity of all vendors self-reporting

Interacts with all internal & external partners to drive timely deliverables & resolutions

Supports day -to-day vendor interactions to ensure vendors are meeting all oversight deliverables in timely manner

Develops and communicates new compliance requirements and processes to internal team and partners.

Reviews and tracks new contract requests and special projects as assigned

Ensures credentialing information is complete based on the requirements of the specific provider type.

Reviews contract pricing and configuration to ensure the terms of agreement have been loaded accurately.

Reviews contracts addendums and amendments before sending to Finance for completeness and appropriate approval / signatures

Works with UM department to resolve authorization issues that impact ancillary provider networks.

Administers the Sidewinder Tracking Application for the department and trains new employees on the tracking system.---Troubleshoots claims issues with internal and external parties.

Coordinates membership eligibility files and reviews capitation payments to vendors while assuring all applicable plan codes are appropriately loaded into the system.

Resolves elevated member calls regarding eligibility files

-Assists Provider Relations with questions in regards to paperwork submissions and contract issues.

Researches and resolves routine provider operational issues and questions

Tracks different types of requests coming into the department.

MINIMUM QUALIFICATIONS ---- Education ---- State the minimum required for the job ---- Education Level Education Details Required/Preferred ---- An Associate's Degree in a related field required---or equivalent work experience---A Bachelor's Degree in a related field Preferred

Work Experience ---- 2+ years of experience in a managed care environment with a focus on provider relation configuration credentialing vendor oversight vendor auditing or related ancillary experience

Microsoft Word Proficient in Microsoft Office such as Word. Excel and Outlook Intermediate Required

Microsoft Excel Intermediate Required

Microsoft Outlook Intermediate Required

location: Tampa, Florida

job type: Contract

work hours: 8 to 5

education: Bachelor's degree

experience: 2 Years

responsibilities:

JOB SUMMARY

Coordinates and controls the workflow occurring in and out of the department

Tracks and reviews contracts and credentialing information within the unit

Coordinates with other functional departments as required.

ESSENTIAL FUNCTIONS

Liaison between all cross functional partners to communicate and resolve issues that arise between the departments

Tracks different types of requests coming into the department

Quality check integrity of all vendors self-reporting

Interacts with all internal & external partners to drive timely deliverables & resolutions

Supports day -to-day vendor interactions to ensure vendors are meeting all oversight deliverables in timely manner

Develops and communicates new compliance requirements and processes to internal team and partners.

Reviews and tracks new contract requests and special projects as assigned

Ensures credentialing information is complete based on the requirements of the specific provider type.

Reviews contract pricing and configuration to ensure the terms of agreement have been loaded accurately.

Reviews contracts addendums and amendments before sending to Finance for completeness and appropriate approval / signatures

Works with UM department to resolve authorization issues that impact ancillary provider networks.

Administers the Sidewinder Tracking Application for the department and trains new employees on the tracking system.---Troubleshoots claims issues with internal and external parties.

Coordinates membership eligibility files and reviews capitation payments to vendors while assuring all applicable plan codes are appropriately loaded into the system.

Resolves elevated member calls regarding eligibility files

-Assists Provider Relations with questions in regards to paperwork submissions and contract issues.

Researches and resolves routine provider operational issues and questions

Tracks different types of requests coming into the department.

MINIMUM QUALIFICATIONS ---- Education ---- State the minimum required for the job ---- Education Level Education Details Required/Preferred ---- An Associate's Degree in a related field required---or equivalent work experience---A Bachelor's Degree in a related field Preferred

Work Experience ---- 2+ years of experience in a managed care environment with a focus on provider relation configuration credentialing vendor oversight vendor auditing or related ancillary experience

Microsoft Word Proficient in Microsoft Office such as Word. Excel and Outlook Intermediate Required

Microsoft Excel Intermediate Required

Microsoft Outlook Intermediate Required

qualifications:

JOB SUMMARY

Coordinates and controls the workflow occurring in and out of the department

Tracks and reviews contracts and credentialing information within the unit

Coordinates with other functional departments as required.

ESSENTIAL FUNCTIONS

Liaison between all cross functional partners to communicate and resolve issues that arise between the departments

Tracks different types of requests coming into the department

Quality check integrity of all vendors self-reporting

Interacts with all internal & external partners to drive timely deliverables & resolutions

Supports day -to-day vendor interactions to ensure vendors are meeting all oversight deliverables in timely manner

Develops and communicates new compliance requirements and processes to internal team and partners.

Reviews and tracks new contract requests and special projects as assigned

Ensures credentialing information is complete based on the requirements of the specific provider type.

Reviews contract pricing and configuration to ensure the terms of agreement have been loaded accurately.

Reviews contracts addendums and amendments before sending to Finance for completeness and appropriate approval / signatures

Works with UM department to resolve authorization issues that impact ancillary provider networks.

Administers the Sidewinder Tracking Application for the department and trains new employees on the tracking system.---Troubleshoots claims issues with internal and external parties.

Coordinates membership eligibility files and reviews capitation payments to vendors while assuring all applicable plan codes are appropriately loaded into the system.

Resolves elevated member calls regarding eligibility files

-Assists Provider Relations with questions in regards to paperwork submissions and contract issues.

Researches and resolves routine provider operational issues and questions

Tracks different types of requests coming into the department.

MINIMUM QUALIFICATIONS ---- Education ---- State the minimum required for the job ---- Education Level Education Details Required/Preferred ---- An Associate's Degree in a related field required---or equivalent work experience---A Bachelor's Degree in a related field Preferred

Work Experience ---- 2+ years of experience in a managed care environment with a focus on provider relation configuration credentialing vendor oversight vendor auditing or related ancillary experience

Microsoft Word Proficient in Microsoft Office such as Word. Excel and Outlook Intermediate Required

Microsoft Excel Intermediate Required

Microsoft Outlook Intermediate Required

skills: MS Office

Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.