PROVIDER NETWORK MANAGER jobs in Miami, FL

Position Summary

The Data Integrity Specialist is responsible for supporting the Configurations and Data Integrity Manager with the organization's overall claims, eligibility and provider database management, security, and operations. Acts as a liaison between the health plan, external agencies, internal teams to ensure accurate and complete data reporting for provider, credentialing, audits, contracting or various related data.

Duties and Responsibilities

• Maintain Humana Centers in TPA System (Ortho and DNS).
• Maintain PCP for Conviva Center TPA System Ortho.
• Retrieve files for Eligibility, Capitation and Accumulator files to ensure proper loading into TPA System.
• Generate all Health Plan Compliance Reporting Requirements within reporting timeline.
• · Obtain, interpret, and format Capitation Files in TPA System
• · Load Schedules, and Eligibility and Capitation in TPA System.
• · Research and load CPT codes along with their allowable reimbursement in core claims system.
• · Configure in TPA System CPT code with remit reasons.
• · Investigate issues and coordinate efforts between the health plan and related departments and external agencies to correct data discrepancies.
• Configure Medicare/Medicaid/Commercial interest rates in TPA system.

Knowledge

• Associates Degree or a minimum 1-year experience in healthcare data management.
• Knowledge of medical terminology, customer service, claims processing and/or customary and reasonable cost containment, and coordination of benefits and diagnosis coding preferred.

Skills

• Strong knowledge of Microsoft applications: Outlook, access database, excel, word and basic computer navigation.

Job Type: Full-time

Pay: $45,000.00 - $50,000.00 per year

Benefits:

• 401(k)
• Dental insurance
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Parental leave
• Tuition reimbursement
• Vision insurance

Schedule:

• 8 hour shift

Language:

• English (Required)

Ability to Commute:

• Doral, FL 33178 (Required)

Ability to Relocate:

• Doral, FL 33178: Relocate before starting work (Required)

Work Location: In person