Provider Database Specialist
CorrectCare - Integrated Health - Lexington, KY

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CorrectCare - Integrated Health provides medical networks, supplies management, operational support for medical service providers and correctional institutions and offers leadership to related businesses.

CorrectCare - Integrated Health, Inc. is currently seeking a bright, motivated individual to join our expanding staff.

Position Title : Provider Database Specialist

Position Summary : The purpose of the Provider Database Specialist is to research, analyze and load provider information for accurate payment of claims processing in accordance with provider contracts and PPO information received.

Essential Functions :
Load provider demographic data & Contract Information for all lines of business.
Create Fee schedules as required for contracts received.
Review CMS website for updates to contracts based on Medicare guidelines.
Work multiple daily reports as received and forward to IT department daily.
Responsible for tickets related to provider issues in the edit/exception portal and insure they are worked in 5 business days.
Provide management weekly reports for outstanding and unresolved tickets.
Perform various other duties assigned by management.

Qualifications (Education, Training, Experience, Competencies):

High School diploma or equivalent.
2 years prior claims processing experience and/or provider contract experience.
Ability to understand and interpret current CPT, ICD9, DRG, and HCPCS coding practices in accordance with Medicare and HIPAA Guidelines.
Must have strong interpersonal skills and a professional demeanor; ability to work independently on projects as well as contribute to team efforts; and superior communication and organizational skills.
Accurate data-entry skills.
Excellent time management skills.
Proficient with Microsoft applications (Word, Excel, Outlook) and database systems.

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