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Network Data Specialist I-III (Remote) (PS27675)Location: United StatesNewRequisition #: PS27675Your Talent. Our Vision. At Amerigroup, a proud member of the Anthem, Inc. family of companies focused on serving Medicaid, Medicare and uninsured individuals, it’s a powerful combination. It’s the foundation upon which we’re creating greater access to care for our members, greater value for our customers and greater health for our communities. Join us and together we will drive the future of health care.This is an exceptional opportunity to do innovative work that means more to you and those we serve.Network Data Specialist I-III (PS27055)Please note: This position will be filled at either the I, II, or III level. The hiring manager will determine the appropriate level based upon the selected applicant's experience and skill set relative to the qualifications listed for this position.LEVEL IThis role is responsible for accurate and timely maintenance of provider information on claims and provider databases. Primary duties may include, but are not limited to:Assists in synchronization of data among multiple claims systems and application of business rules as they apply to each database.Validates the data to be housed on provider databases and ensuring adherence to business and system requirements of customers as it pertains to contracting, network management and credentialing.LEVEL IIThis role is responsible for accurate, timely maintenance of critical provider information on all claims and provider databases. Primary duties may include, but are not limited to:Maintains critical provider information on all claims and provider databases.Synchronizes data among multiple claims systems and application of business rules as they apply to each database.Validates the data to be housed on provider databases and ensuring adherence to business and system requirements of customers as it pertains to contracting, network management and credentialing.LEVEL IIIThis role is responsible for accurate, timely maintenance of complex provider information and synchronization of data on all claims and provider databases including expertise on business requirements for multiple business regions. Primary duties may include, but are not limited to:Leads the department in problem identification, analysis, and resolution for multiple system provider database issues.Participates in system testing and analysis in support of new functionality, new system processes, and business rules changes.Validates the data to be housed on provider databases and ensure adherence to business and system requirements of customers as it pertains to contracting, network management and credentialing.Researches and resolves complex exceptions and error reports, determine regional/cap/business indicators for multiple business areas to assure accurate reimbursement based on provider contract and area fee schedules.Determines training needs and train less experienced associates and outside customers on multiple provider data base systems and business requirements.Audits for functional and business applications, and report accuracy standards.LEVEL IRequires a H.S. diplomaBasic PC office software; or any combination of education and experience, which would provide an equivalent background.1-3 years of experience in claims processing, provider, or credentialing preferred.LEVEL IIRequires a H.S. diploma3-5 years related experience; or any combination of education and experience, which would provide an equivalent background.LEVEL IIIRequires a H.S. diploma3-5 years Provider Database Rep experienceOr any combination of education and experience, which would provide an equivalent background.Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.
