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Provider Information Analyst

  • Location: Durham, North Carolina, 27707
  • Job Type:Contract

Posted 7 days ago

Our Healthcare Insurance client is seeking a Provider Information Analyst to join their team for a contract role! 

Our client has more than 5,000 employees and is the number 1 health insurer in the state of North Carolina serving more than 3.89 million customers.

Our client's goal is to provide innovative solutions that simplify the health care system, improve efficiency and outcomes, and help rein in costs

Position: Provider Information Analyst
Location: Remote due to COVID-19, then possibly onsite in Durham, NC 
Term: 6 months 
Day-to-Day Responsibilities:

Compile appropriate information to make requested contractual and demographic updates and changes related to provider data in the
systems of record in an accurate, complete and timely manner. Manage and sustain positive provider relationships. Configure providers
and networks in systems of record, assign provider numbers and communicate with provider community. Facilitate accurate financial claims
payment and provider directory processes. Represent company to external provider communities and internal stakeholder groups.

  • Accurately complete provider enrollment, terminations, demo changes and contracts in provider systems of record to ensure appropriate claims payment in accordance with contractual language.
  • Compile, analyze, and verify the required information for provider enrollment, contracts, and maintenance for completeness and accuracy, and enter it into the systems of record.
  • Communicate, orally and in writing, directly with providers to resolve questions and issues regarding updates and changes in the systems of record.
  • Research, respond to, analyze and resolve complex claims issues related to provider setup and provider eligibility on a daily basis.
  • Create resolution documents to address provider issues and increase provider satisfaction. Utilize probing and problem solving methods to resolve all inquiries/requests. Identify, understand and anticipate providers unexpressed needs and concerns.
  • Provide cross functional support and serve as Subject Matter Experts (SMEs) or second tier resolution to internal and external provider teams (i.e., PSA team, Credentialing, Contracting, Provider Service Consultants, etc).
  • Manage timely responses to external provider inquiries and requests. Evaluate new service requests from providers to determine appropriate actions for recording into the systems of record.
  • Perform gap analysis on requests and follows through with communication and/or education to providers on internal BCBSNC process and issues.
  • Recommend, and participate in process improvement opportunities for PRiMO Operations. Identify system problems, gaps or inconsistencies in workflows and/or processes. Recommend appropriate updates, alternatives and solutions.

Is this a good fit? (Requirements): 

  • Associates/Bachelors degree or certification in business or health related field with demonstration of strong analytical skills in business, systems or information management (can be through coursework, internships or relevant work experience).
  • MS Office knowledge required
  • Ability to adapt to changes quickly
  • Is able to work in a high production environment
  • Time Management and Strong Organization skills
  • Team Mentality
  • Person must be very analytical, good to have provider data knowledge, previous extensive claim background, or a customer service background.