Provider Data Services AnalystPrimary Location: San Diego, CA
Additional Locations: CA-San Diego Apply
- Performs baseline demographic transaction updates in provider system applications in support of claim adjudication and Provider directory
- Performs intake triage and responds to network inquiries, escalates when necessary.
- Provides on-going department support in research and analysis essential to resolving concerns/issues raised by providers and other internal/external customers.
- Sends requests to individual providers and/or delegated groups to verify information on file and follows up as needed to ensure information is received.
- Conducts audits of provider information and escalates issues for resolution as appropriate.
- Demonstrated PC skills, including Microsoft Office products and internet navigation skills.
- Strong Excel skills a plus.
- Previous industry experience or claims processing preferred.
- High School Diploma or G.E.D.
- Understanding of medical terminology.
- Strong knowledge of benefit plans, policies and procedures.
- Oral and written communication skills.
- Ability to maintain accuracy and production standards.
- Technical skills.
- Analytical skills.
- Excel and Access experience.
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