AmeriHealth Caritas Provider Maintenance Technician in Philadelphia, Pennsylvania

Provider Maintenance Technician

Location: Philadelphia, PA

Telecommuter?: No

ID**: 16326

Your career starts now. We’re looking for the next generation of health care leaders.

At AmeriHealth Caritas, we’re passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we’d like to hear from you.

Headquartered in Philadelphia, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at www.amerihealthcaritas.com .

Responsibilities:

Under the direct supervision of the Provider Maintenance Supervisor, the Provider Maintenance Technician is responsible for maintaining both participating and non-participating provider records in the provider database, mapping claims in the invalid provider queue, resolving provider related issues for claims suspended to Provider Maintenance. Coordinates the panel transfer process. Completes projects as assigned by Supervisor. Interacts with internal/external clients on provider maintenance activities.

Communicates new provider numbers to either the provider’s office or to the client within 24 hours, to ensure that providers bill with appropriate provider number.

Coordinates the provider mailing for all claims in the invalid provider queue that could not be processed due to missing or invalid information.

Researches and resolves returned checks and provider mail.

Education/Experiences:

  • Required Associate’s Degree or commensurate work experience.

  • Required minimum 1 year related work experience in Heatlhcare.

  • Required minimum 2 years’ experience in claims and/or call center.

  • Required software systems including Windows 2000, MS Office, IMAX (external Claims editing), Facets preferred. Knowledge of Word, Excel and ACCESS is a plus.

  • Preferred knowledge of different types of providers, claims process experience.

EOE Minorities/Females/Protected Veterans/Disabled