Sr. Provider Services Specialist

About SCAN

SCAN Group is a not-for-profit organization dedicated to tackling the most pressing issues facing older adults in the United States. SCAN Group is the sole corporate member of SCAN Health Plan, one of the nation's leading not-for-profit Medicare Advantage plans, serving more than 285,000 members in California, Arizona, Nevada, and Texas. SCAN has been a mission-driven organization dedicated to keeping seniors healthy and independent for more than 40 years and is known throughout the healthcare industry and nationally as a leading expert in senior healthcare. SCAN employees are a group of talented, passionate professionals who are committed to supporting older adults on their aging journey, while also innovating healthcare for seniors everywhere. Employees are provided in-depth training and access to state-of-the-art tools necessary to do their jobs, as well as development and growth opportunities. SCAN takes great pride in recognizing our team members as experts in their fields and rewarding them for their efforts. If you are interested in becoming part of an organization that is innovating senior healthcare visit www.thescangroup.org, www.scanhealthplan.com, or follow us on LinkedIn; Facebook; and Twitter.

The Job

The Sr. Provider Services Specialist is responsible for ingesting accurate provider data into SCAN's IKA system and ensures that all provider data related requests from the Medical Group and various SCAN departments are handled in an accurate and timely manner in accordance with Federal/State, Regulatory and Plan standards of the Company. The Sr. Provider Services Specialist utilizes a variety of proprietary and external tools in order to research and validate data integrity prior to loading information into the Claims system. The Sr. Provider Services Specialist acts as a Subject Matter Expert on a variety of topics in the team, helping to write Job Aids and Desktop Procedures, and takes a lead role in implementing new Standard Operating Procedures as the team evolves in Process and Technology adoption.

You Will

• Manage the addition/updates/affiliations for Providers (1099, business and billing addresses), Physcians (contracted vs non-contracted), Affiliate Independent Physician Associates (IPA) to physician record, Panel updates for Primary Care Physicians (PCPs) and Specialists, and Load providers for CMS sweep and Member MOOP issues.
• Perform provider screening according to complex business rules, online resources, and a variety of tools to verify provider set-up requests.
• Apply business rules to determine if provider update request should be rejected, processed, or forwarded to Network Management Research team for verification.
• Process provider update requests, provider not found claim and encounter rejects within productivity measures set by the department leadership.
• Monitor assigned tasks in order to facilitate the accurate and timely turnaround of medical group requests, daily work, and routine provider data maintenance. Function as point-of-contact for medical group requests.
• Research and facilitate resolution of issues related to provider data, such as returned checks and provider addresses, duplicate provider records, etc.
• Communicate necessary information regarding new providers to internal SCAN departments. Respond to inquiries from other departments via email, system inquiry routing system, or telephone.
• Build strong collaborative relationships internally at SCAN between Shared Services, Network Management, Member Services, Claims and all other business units.
• Acts as a Subject Matter Expert on a variety of topics in the team. Helps to write Job Aids and Desktop Procedures.
• Takes a lead role in implementing new Standard Operating Procedures as the team evolves in Process and Technology adoption. Acts as a point of escalation for resolving issues and escalates further as needed with strong communication and a sense of urgency in resolving issues. File documents according to departmental guidelines.
• All other duties as assigned.

Your Qualifications

• Bachelor's Degree or equivalent experience
• 5-7 years of experience working in health care provider operations, or equivalent experience with credentialing, claims, and provider data management
• Strong understanding of CMS 1500 and UB-04 Claim Form, National Provider Identifier (NPI), and provider set up requirements such as excluded and optout provider settings.
• Knowledge of Access database, Enterprise Systems, and Claims System, preferred.
• Ability to prioritize tasks and meet deadlines with minimal supervision.
• Accurate data entry skills and proficiency in MS Word, Excel, and Outlook.
• Understands how and when to communicate escalation on issues to resolve, proactively propose solutions, and forge relationships across teams to foster solutions.
• Ability to prioritize tasks and meet deadlines with minimal supervision.
• Advanced analytical skills
• Basic problem-solving skills
• Good communication and interpersonal skills

What's in it for you?

• Base Pay Range: $25.38 - $40.62 (Hourly)
• Work Mode: Mostly Remote
• An annual employee bonus program
• Robust Wellness Program
• Generous paid-time-off (PTO)
• 11 paid holidays per year, plus 1 additional floating holiday
• Excellent 401(k) Retirement Saving Plan with employer match
• Robust employee recognition program
• Tuition reimbursement
• An opportunity to become part of a team that makes a difference to our members and our community every day!

We're always looking for talented people to join our team! Qualified applicants are encouraged to apply now!

At SCAN we believe that it is our business to improve the state of our world. Each of us has a responsibility to drive Equality in our communities and workplaces. We are committed to creating a workforce that reflects our community through inclusive programs and initiatives such as equal pay, employee resource groups, inclusive benefits, and more.

SCAN is proud to be an Equal Employment Opportunity and Affirmative Action workplace. Individuals seeking employment will receive consideration for employment without regard to race, color, national origin, religion, age, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender perception or identity, age, marital status, disability, protected veteran status or any other status protected by law. A background check is required.

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