Posted 2 weeks ago

Network and Reimbursement Specialist

Company: Innovista Health Solutions
Category: Accounts, Billing

 Oak Brook

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.