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Provider QueTech

Philadelphia, Pennsylvania, United States
January 03, 2019


Required Skills

•Associates Degree/commensurate work experience

•Related work experience in Healthcare

•Software systems including Windows 2000, MS Office, IMAX(external Claims editing), Facets

•Knowledge of Word, Excel and ACCESS

•Ability to research to analyze provider information submitted on claims


•Identify and maps claims to the appropriate provider number for claims in the invalid provider queue.

•Ensures that work is completed according to the service level agreement.

•Coordinates the provider mailing for all claims in the invalid provider queue that could not be processed due to missing or invalid information.

•Responsible for working on projects assigned by Supervisor.

•Performs other related duties and projects as assigned.

•Adheres to KMHP policies and procedures.

•Supports and carries out the Mercy Mission & Values.

•Attends required training on an annual basis.

•Ability to enter/change provider information in Facets and meet the minimal accuracy standard.

•Meets turn-around time standard for Invalid Provider Queue claims identification and resolution.

•Demonstrates good customer service experience to both internal and external customers.

•Demonstrates flexibility and team support to ensure efficient, effective operations, which crosses all LOBs.

•Ability to respond to extreme needs such as backlogs and staff constraints by contributing above and beyond routine work effort and hours.

•Ability to work well with co-workers and create a positive work environment

•Demonstrates a willingness and aptitude to be cross-trained in other functions to ensure efficient operations during times of peak volume or low staffing.