Provider Research Specialist

Job Responsibilities

• Monitors provider system data files and creates and maintains contract fact sheets for each contracted provider, including but not limited to: participation in all BCBST networks, special arrangements, and reimbursement data in all BCBST systems.
• Works closely with Provider Relations and Provider Service Organization staff to resolve provider and member problems or complaints related to provider participation status.
• Investigates all information associated with contract(s) to ensure accuracy and completeness (i.e., profile form, change forms, provider leaving group forms, signature pages, reimbursement schedules, escalation, incentive, pre-application information, credentialing information and electronic commerce information).
• Works closely with the provider community to get corrected data needed from the research of the contracts and forms received prior to having contract data entered and maintained in the FACETS system.

Job Qualifications

Education

• High School Diploma or equivalent

Experience

• 3 years – Experience in a Support function or Customer Service required

Skills\Certifications

• Proficient in Microsoft Office (Outlook, Word, Excel and Powerpoint)
• Proficient oral and written communication skills
• Proficient interpersonal and organizational skills