Staffing Agency Houston - Contract & Direct Hire
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Claims Processing Analyst (Remote)

Claims Processing Analyst (Remote)

This is a 6+ month contract position and you can work remotely although Houston area candidates are strongly preferred. You will be responsible for accurate and timely maintenance of provider information on all claims and provider databases. You will also ensure that that provider information entered into databases adheres to business policies and state requirements.

Duties
Load new providers contracted to our network in QNXT and Cactus
Execute changes in provider data and contracts as requested by Provider Network Management team
Create contract records for out of network providers to properly adjudicate claims received
Research and respond to inquiries related to provider data and affiliation status
Loads and maintains provider information in an accurate and timely manner to meet department’s standards of turnaround time and quality
Monitors pended claims and work queues to update appropriate systems
Identifies claims impacted by configuration changes done in the system and sends reports to the claims administration department for reprocessing

Requirements

1 – 3 years experience in Managed Care, provider data and claims processing required
Knowledge of managed care business practices as it pertains to providers, credentialing and contracts as required by the Health Plan
Additional preferred knowledge includes: provider contract configuration, TX Medicaid, Master Provider File

I.T. Staffing

Description

This is a 6+ month contract position and you can work remotely although Houston area candidates are strongly preferred. You will be responsible for accurate and timely maintenance of provider information on all claims and provider databases. You will also ensure that that provider information entered into databases adheres to business policies and state requirements.

Duties
Load new providers contracted to our network in QNXT and Cactus
Execute changes in provider data and contracts as requested by Provider Network Management team
Create contract records for out of network providers to properly adjudicate claims received
Research and respond to inquiries related to provider data and affiliation status
Loads and maintains provider information in an accurate and timely manner to meet department’s standards of turnaround time and quality
Monitors pended claims and work queues to update appropriate systems
Identifies claims impacted by configuration changes done in the system and sends reports to the claims administration department for reprocessing

Requirements

1 – 3 years experience in Managed Care, provider data and claims processing required
Knowledge of managed care business practices as it pertains to providers, credentialing and contracts as required by the Health Plan
Additional preferred knowledge includes: provider contract configuration, TX Medicaid, Master Provider File

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