Job Description

Your career starts now. We\xe2\x80\x99re looking for the next generation of health care leaders. At AmeriHealth Caritas, we\xe2\x80\x99re passionate about helping people get care, stay well and build healthy communities. As one of the nation\'s leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we\xe2\x80\x99d like to hear from you. Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at www.amerihealthcaritas.com.
Responsibilities: Under the direct supervision of the Provider Enrollment Supervisor, the Provider Enrollment Specialist is responsible for maintaining both participating and non-participating provider records in the provider database, mapping claims in the invalid provider queue, resolving provider related issues for claims suspended to Provider Enrollment. Executes the panel transfer process. Completes projects as assigned by Supervisor. Interacts with internal/external clients on provider maintenance activities.

• Communicates notification of changes to appropriate providers, members and other departments within the contracted time frame.
• Coordinates the provider mailing for all claims in the invalid provider queue that could not be processed due to missing or invalid information.
• Researches and resolves returned checks and provider mail.
• Assists provider and internal customer by responding to and resolving all request and inquiries related to the Panel Transfers,
• Panel Releases, & Special Needs PCP assignments process.
• Completes department reports and logs as assigned.
• Ensures that work is completed according to service level agreements.
• Attends required training on an annual basis.

• Associate\xe2\x80\x99s Degree/commensurate work experience.
• Minimum 1 year related work exp in Heatlhcare.
• Minimum 4 years\xe2\x80\x99 exp in claims and/or call center.
• Knowledge of different types of providers, claims process experience preferred.
• Customer service experience required.
• Software systems including Windows 2000, MS Office, IMAX (external Claims editing),
  Facets preferred.
• Knowledge of Word, Excel and ACCESS is a plus.