Network and Reimbursement Specialist
Company: Innovista Health Solutions
Category: Accounts, Billing
Type: Full Time
Innovista Health Solutions is seeking a Network and Reimbursement Specialist to join their team to maintain all data within the claims processing system including provider demographics, contracts, fee schedules, CPT/HCPCS codes and ICD9/ICD10 codes. DUTIES AND RESPONSIBILITIES:
- Maintain accurate provider files. Enter provider data, terminations, changes, and contracts.
- Master file maintenance, including but not limited to research, set-up and maintenance of all diagnosis, CPT/HCPCS and other medical codes as identified.
- Fee schedule maintenance, including but not limited to research, set-up and maintenance of all fee schedules and provider contract rates.
- Research NPI numbers and gather similar licensure data on providers entered into the claims processing system to ensure each provider is appropriately loaded.
- Work with the Claims Manager to create reports of common provider entry errors to perform frequent audits of data loaded to ensure accuracy.
- Work closely with the EDI Specialist to identify provider related EDI errors.
- Coordinate directly with the Provider Relations & Contracting departments regarding updates.