Job Description:
JOB SUMMARY/PURPOSE
Serves as a senior technical lead to ensure that provider data is entered and administered properly and in a timely manner. Responsible for staying current on regulations and compliance issues. Leads the advocation of the PDM data entry process as it applies to cross-functional data support. Meets regularly with other Provider Services departments to ensure proper workflow development and policies/procedures are maintained.
DEPARTMENT DESCRIPTION
Samaritan Health Plans (SHP) operates a portfolio of health plan products under several different legal structures: InterCommunity Health Plans, Inc. (IHN) is designated as a regional Coordinated Care Organization (CCO) for Medicaid beneficiaries; Samaritan Health Plans, Inc. offers Medicare Advantage, Commercial Large Group, and Commercial Large Group PPO and EPO plans; SHP is also the third-party administrator for Samaritan Health Services' self-funded employee health benefit plan. As part of an Integrated Delivery System, Samaritan Health Plans is strategically and operationally aligned with Samaritan Health Services' mission of Building Healthier Communities Together
EXPERIENCE/EDUCATION/QUALIFICATIONS
Associate's degree or equivalent experience required.
Two (2) years experience in Provider Services required.
Two (2) years experience in Health Plan Insurance Plans required.
Previous Facets, or similar provider data or claims processing system experience required.
Previous claims experience preferred.
Experience in documenting processes, creating workflows and policies required.
Knowledge of compliance requirements and procedures preferred.
Critical and analytical thinking skills required.
Project implementation experience preferred.
Experience in other provider related healthcare departments, such as credentialing, provider relations or contracting preferred.
Position Urgency:
Normal
Shifts:
Days (0800-1700), no weekends
State License Details:
Not Needed
Minimum Years of Experience:
2
Minimum Guaranteed Hours:
40
Specialty Type:
Clerical
Sub Specialty:
Medical Staff Coordinator, Data Quality Specialist
Bilingual:
No
EMR Used:
No Listing
Holiday Coverage Required:
No