Audits Provider Contract Module to ensure compliance with policies and procedures. Ensures that protocols are followed with regard to provider contract, contract reimbursement, established guidelines.
Essential Functions & Responsibilities
- Conduct audits of the entry made into the Provider Admin Module to ensure the accuracy in entry and to ensure adherence to the department’s contract loading guidelines.
- Review and audit all contract uploads performed by IT to ensure the upload was performed accurately.
- Review and audit provider entries by the staff as a result of a claim edit.
- Review and audit all contract entries by the staff as the result of a request from the Specialty Network, Credentialing and/or UM.
- Review and audit custom fee schedules created and updated by the provider admin team.
- Ability to safely and successfully perform essential job functions consistent with the ADA, FMLA, and other federal, state, and local standards, including meeting qualitative and/or quantitative productivity standards.
- Ability to maintain reasonably regular, punctual attendance consistent with the ADA, FMLA, other federal, state, and local standards, and company attendance policies and procedures.
- Ability to come to work and work the regular schedule and shift for the position.
- Compliance with all personnel policies and procedures.
- Special projects and other duties as assigned by senior management.
- Perform additional duties and related essential duties as assigned.
Required Education and Experience
- Minimum 3 years experience in a medical office claims environment withemphasis in provider contracting for purposes of systemic administration.
- Knowledge of Medicare, Medicaid and Commercial lines of business.