ADMINISTRATION REPRESENTATIVE

PNA ADMINISTRATION REPRESENTATIVE

Provider Administration Location: Austin, Texas Supervisor Director Provider Administration Job Classifications for EEOC Exempt or Non-Exempt Officials / Manager, Professional, Technician Sales Worker, Office/Clerical, Laborer, Service Worker Job Summary Responsible for credentialing all incoming physician agreements and responsible for processing network updates for the IPA division of the Provider Administration department. Various departmental projects as assigned. Key Responsibilities Credential direct provider agreements following the required guidelines within the required turnaround time frame. Perform Primary Source verifications, state license verifications and/or Hospital Privileges verification on all incoming direct provider agreements. Additional verifications are also performed on specific states. Query National Practitioner Data Bank and identify those agreements needing the attention of the Medical Review Committee. Performs Quality Control verifications on Pended and Non-Pended Claims. Communicate with providers and facilities written or verbal regarding various questions or contractual issues. Assist with the Provider Administration Departmental Queue Line to answer contracting questions from providers or facilities. Process updates for directly contracted providers utilizing Word, Excel, and other acceptable update formats. Process updates for IPA Networks utilizing Word, Excel, and other acceptable update formats. (Data Entry). Communicate with IPA Networks contacts by email, phone, or fax regarding update question or clarifications. Log and save all incoming direct and IPA Network updates by utilizing the Microsoft Outlook program. Multi-task on several departmental projects. Process various time sensitive projects as assigned. Cross train on departmental tasks. Maintain daily production reports. At various times back up for Customer Care Calls utilized SO2 call tracking system. Adhere to the USA Managed Care Organization’s information Security Policies and Procedures. Adhere to HIPAA Guidelines and Requirements. Qualifications Minimum of 2 years in an administrative capacity. High school graduate of equivalent. Minimum of 3 years in an administrative capacity. High school graduate of equivalent. Minimum of 5 years in an administrative capacity in the healthcare industry preferred. High school graduate of equivalent. Qualifications/Skill Requirements Typing 30 wpm 10-key Y or N #J-18808-Ljbffr USA Quality Staffing INC