Performs analysis and completes entry into Salesforce for all provider directory updates and completes provider demographic updates, including Adds, Changes, and Terminations. Assists with audit of all network provider entry into Facets to ensure accuracy and the integrity of the network provider data. Completes phone verification calls to providers to obtain required data elements for provider directory updates as defined by state regulations. Performs routine assignments with minimal supervision.
Reviews contracted provider data. Performs close examination of network provider directory update form and completes the entry into the Salesforce system.
Verifies provider s group affiliations, and works with Contract Administrator and Sr Contract Specialist to identify group providers in need of directory update audit, and submit the spreadsheet to the group contact for updates. Prepare completed updates and submit to Sr Contract Specialist for update into Salesforce.
Utilizes NPPES NPI Registry to verify provider NPI and update per NPI website.
Identifies updates of provider specialty, education, American Board Certification, and state license number and forwards to Credentialing for verification.
Contacts provider to obtain required data elements to complete directory update.
Assists Contract Administrator with maintaining updates to the job aides, makes recommendations for process updates, and maintains updates to the job aides based on recommendations from the Contract Administrator.
Assists with audit of applications, adds, changes, and terms into the Salesforce and Facets systems and completes audit spreadsheets and provides feed back to the Contract Administrator.
Reviews and updates error reports received from payers as needed for PPO USA.
Assists in research and resolution for provider directory issues and other payer requests as received from PPO USA.
Provide weekly status reports to Contract Administrator to be used for reporting to Supervisor, Provider Relations, and PPO USA.
Assists with completing provider entry for all applications, adds, changes, and terminations.
Assists with other tasks as assigned.
Requires high school diploma or equivalent
Requires five years of data entry experience
Requires effective written and verbal communications skills to answer questions from staff and respond to inquiries
Requires alpha numeric entry of 10,000 KPH
Requires analytic ability to prepare departmental reports. Requires the ability to compare data and resolve discrepancies
Requires proficiency with Word and Excel
Skills (Testing) Requirements
Data Entry Alpha Numeric (10,000 kph)
GEHA is an Equal Opportunity Employer. GEHA will not discriminate against employees or applicants because they have inquired about, discussed, or disclosed their compensation or the compensation of another employee or applicant. Our company's corporate headquarters is located in Lee's Summit near Douglas Rd and I-470 with a total of five locations in the Kansas City metropolitan area.