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Claims Management - Provider Network Assistant

Virtual Req #711
Thursday, November 11, 2021

Our goals are to provide excellent service, utilize advanced technology, and proficiently deliver results. To accomplish these goals, we constantly seek individuals who look for ways to do things better. We are a company whose culture cultivates teamwork, rewards excellence, focuses on quality for every aspect of our business, and promotes community involvement.
 

Tabula Rasa HealthCare (TRHC) is a leader in providing patient-specific, data-driven technology and solutions that enable healthcare organizations to optimize performance to improve patient outcomes, reduce hospitalizations, lower healthcare costs, and manage risk. Medication risk management is TRHC’s lead offering, and its cloud-based software applications, including EireneRx® and MedWise™, provide solutions for a range of payers, providers and other healthcare organizations.

 

TRHC empowers our employees to provide excellent service, utilize advanced technology, and proficiently deliver results. Our 32Fundamentals are what we are and who we are.  Our culture cultivates teamwork, rewards excellence, focuses on quality for every aspect of our business, and promotes community involvement. As a part of our team, you will help us bring innovative service models to healthcare, improving patient outcomes.

Job Description:                       Provider Network Assistant

 

 

Summary:

Under the supervision of the Provider Network Supervisor, the Provider Network Assistant is responsible for creating provider and vendor records in the claims processing system and completing other tasks that support the Provider Network department.

 

Essential Functions:

  • Creates provider and vendor records in claims processing system
  • Manages assigned email communication received within the Provider Network department
  • Effectively reviews and documents provider contract and payment information
  • Assists with removal of rejected claims within the claims processing system

 

Additional Functions:

  • Assists with special projects, as requested
  • Communicates clearly and concisely, with sensitivity to the needs of others
  • Maintains the confidentiality of all company procedures, results, and information about participants, clients, providers and employees
  • Maintains courteous, helpful and professional behavior on the job
  • Establishes and maintains effective working relationships with co-workers
  • Follows all Policies and Procedures and HIPAA regulations
  • Maintains a safe working environment

 

Supervisory Responsibility:

None

 

Travel:

None

 

Knowledge, Skills and Abilities:

  • High School Diploma or equivalent is required
  • Two years of work experience in a Health Plan Management, with exposure to provider contracts, fee schedules and payment methodologies, is preferred
  • Working knowledge of medical terminology and medical claims processing is helpful
  • Knowledge and experience using current computer technology, and a strong knowledge of Excel and Microsoft Word
  • Skilled in establishing and maintaining effective working relationships with clients, and staff at all levels
  • Skilled in data analysis and problem solving using defined methodologies
  • Skilled in problem resolution; recommends suggestions to increase accuracy and/or efficiency
  • Ability to work independently, seeking guidance as needed
  • Ability to take direction and follow instructions for defined processes
  • Ability to independently follow through on projects
  • Ability to communicate professionally, clearly and effectively, verbally and in writing
  • Ability to prioritize effectively
  • Ability to consistently multi-task

 

Physical Demands & Requirements:

  • Communicate by way of the telephone with participants, customers, vendors and staff
  • Operate a computer and other office productivity machinery, such as a calculator, copy machine, fax machine and office printer
  • Remain stationary for extended periods of time
  • Occasionally exert up to 20 pounds of force to lift, carry, push, pull or move objects
  • Visual acuity to perform activities such as identifying, inputting and analyzing data on a computer terminal and/or in hard copy
  • Occasional reaching to retrieve shelved items
  • Occasional bending/stooping

 

Work Environment:

  • This job operates in a professional or home office environment with a conversational noise level
  • No substantial exposure to adverse environmental conditions is expected
  • Moderate pressure to meet scheduled appointments and deadlines

 

Supervised by:                      Provider Network Supervisor

The Company is proud to be an equal opportunity employer. All qualified applicants will receive consideration without regard to ancestry or national origin, race or color, religion or creed, age, disability, AIDS/HIV, gender, marital or family status, pregnancy, childbirth or related medical conditions, genetic information, military service, protected caregiver obligations, sexual orientation, protected financial status or other classification protected by applicable law.

Other details

  • Pay Type Hourly