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Network and Reimbursement Specialist

Company: Innovista LLC
Location: Oak Brook
Posted on: May 6, 2021

Job Description:

NOTE: THIS POSITION HAS THE ABILITY TO WORK REMOTE UNTIL FURTHER NOTICE!The current healthcare landscape is ever-changing, but the desire to provide patients with better, more affordable care is consistent. Healthcare providers are working to evolve and support population health management and today's value models, but there is still uncertainty in the market. Providers need a proven, integrated approach that takes the best of today's technology and matches it with deeply experienced professionals.Innovista Health Solutions is an Illinois-based service organization with management services operations in Illinois and Texas. We are currently looking for a Network & Reimbursement Specialist in our Oak Brook, IL office. At Innovista, we believe that positive forward movement in today's uncertain healthcare market stems from the combination of innovative programs and dedicated people. Join the Innovista team and lead the charge to a better, more efficient healthcare system. JOB SUMMARY:Maintain all data within the claims processing system including provider demographics, contracts, fee schedules, CPT/HCPCS codes and ICD9/ICD10 codes.DUTIES AND RESPONSIBILITIES:Maintain accurate provider files. Enter provider data, terminations, changes, and contracts. Master file maintenance, including but not limited to research, set-up and maintenance of all diagnosis, CPT/HCPCS and other medical codes as identified. Fee schedule maintenance, including but not limited to research, set-up and maintenance of all fee schedules and provider contract rates. Research NPI numbers and gather similar licensure data on providers entered into the claims processing system to ensure each provider is appropriately loaded Work with the Claims Manager to create reports of common provider entry errors to perform frequent audits of data loaded to ensure accuracy Work closely with the EDI Specialist to identify provider related EDI errors. Coordinate directly with the Provider Relations & Contracting departments regarding updates. Perform other duties as assigned Requirements Associate degree or equivalent experience required.At least 2-3 years of relevant professional experience, including billing or claim processing experience a plus. Knowledge of CPT 4, HCPCS and ICD-10 code sets. Specific knowledge of claims, enrollment, and premium business processes in a commercial, Medicare, or Medicaid health plan/TPA organization.Demonstrate excellent organizational skills.Demonstrate effective verbal and written communication skills.Demonstrate analytic skills when problem solving.Proficient in MS Office Applications and ability to learn department and job specific software systems.Demonstrate high attention to detail and a high degree of accuracyAble to commit to Innovista's corporate mission and valuesAble to switch priorities in a positive and effective manner when directed by Company leadership. Able to effectively communicate technical concepts with team members and basic business concepts with team members and internal customers. Eligible for consideration of partial work from home status upon completion of probationary period as designated by the direct supervisor.BENEFITS:Innovista is dedicated to hiring passionate individuals who embody our core values: integrity, determination, and teamwork. We recognize the importance of work-life integration and seek to provide our employees with competitive benefits, which include:Comprehensive health plan options, dental, and vision coverage subsidized by InnovistaOpportunity to work from home, based on position and manager discretionCompany-paid benefits, such as short- and long-term disability, employee life, and ADDiscretionary bonus401(k) with company matchOpportunity for career advancement and growthFlex time options may be available We do not post salary ranges. Salary ranges posted on other sites are not tied to our labor market specifications and are not relevant.

Keywords: Innovista LLC, Chicago , Network and Reimbursement Specialist, Other , Oak Brook, Illinois

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