Provider Database Coordinator
The Provider Database Coordinator is responsible for researching and maintaining Provider files on our clients Health Claims Processing System (HCPS) forgeneration of remittance advice, explanation of benefits (EOB) and Internal Revenue1099's. In addition, this position will assist in the maintenance of medical and dental contract fee schedules and usual customary (U&C) tables.
A. Manage all Provider maintenance requests professionally, accurately and in a
B. Review and research Provider medical and dental claims for complete and
accurate information including, but not limited to; address, phone number, license
number and federal Tax ID numbers.
C. Load accurate Provider information into the HCPS as indicated on the
medical/dental claim form within ten days of receipt of claim/request. Maintain
the non Blue Cross eligible plans on all Blue Cross Providers on a daily/weekly
D. Load PPO network from all third party vendors as applicable to the appropriate
health benefit plan within in a timely manner.
E. Research Anthem Blue Cross and any other third party PPO network to resolve all
Provider contract issues involving participating vs. non participating status and
pricing area issues.
F. Assist in the review and maintenance of Anthem Blue Cross weekly Provider
updates utilizing reports available.
G. Assist in the maintenance and resolution of Internal Revenue requests, 1099
issues and levy??s.
H. Assists in the review of the 1099 edit report at year-end for discrepancies.
I. Validate and maintain W-9 forms for all Providers.
J. Get curious and strive to understand others?? outside triangles, (what they are
needing/wanting to do).
K. Plan and execute work in a helpful and collaborative manner.
L. Be accountable for actually helping, assess and report performance in terms of
impact, making improvements, and course correcting along the way.
M. All other duties as assigned
Working hours: 8:00 AM - 5:00 PM
please refer to qualifications
The following qualifications are preferred to successfully
accomplish this position:
A. High School education or equivalent and/or two years of provider operations
B. Data entry skills with excellent manual dexterity
C. Pleasant and courteous phone skills/oral communication skills
D. Personal computer software skills with basic knowledge of Microsoft Office
E. Healthcare knowledge as it relates to Provider billing practices for medical and
F. Knowledge of Medical Terminology
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San Francisco Fair Chance Ordinance:
Qualified applicants in San Francisco with criminal histories will be considered for employment in accordance with the San Francisco Fair Chance Ordinance.