Provider Operations Specialist (Remote) #36334
Office Call Center
Wayne, PA Contract To Hire Apr 30, 2024
Contemporary Staffing Solutions is seeking a dedicated and detail-oriented Provider Operations Specialist to join our client for a remote opportunity! In this role, you will play a crucial part in operationalizing both new and existing provider contracts, ensuring accuracy and adherence to contractual terms. This Contract-to-Hire opportunity offers $24-$28/Hour!

Responsibilities:
  • Assist in loading and testing provider contracts.
  • Support setup of new contracts, fee schedules, and amendments.
  • Coordinate annual contract rate updates.
  • Handle claims pricing inquiries and coordinate resolutions.
  • Audit contract loads for adherence.
  • Review and align provider demographic data with agreements.
  • Contribute to quality improvement efforts.
  • Adhere to turnaround time standards.
  • Understand organizational strategies.
  • Provide feedback on system needs.
  • Participate in system testing and improvements.
  • Perform other assigned duties.

Required Experience / Education:
  • Associates Degree
  • Minimum of 1 year of experience
  • Experience in a managed care/healthcare environment.
  • Extensive Professional Provider and/or Facility reimbursement experience required.
  • Experience creating fee schedules.
  • Understanding of complex provider contracts.
  • Knowledge of binding terms and provisions in contracts.
  • Functional knowledge of payment methodology.
  • Experience with contract loading systems involving interpreting and programming reimbursement methodologies.
  • Strong analytical and problem-solving skills.
  • Familiarity with Medicare and Commercial reimbursement methodologies.
  • Strong verbal and written communication skills.

Contemporary Staffing Solutions (CSS) has been a leading provider of contract, temporary, temporary-hire & direct hire solutions. We began as a staffing agency and evolved to a national provider of workforce management solutions with a niche recruitment focus in Accounting & Finance, Call Center & Office, Human Resources, Sales & Marketing, & Information Technology. To learn more about CSS, visit our website: www.ContemporaryStaffing.com