Provider Contract Coordinator

Minneapolis, MN

Humera is seeking a Provider Contract Coordinator for our client, a large health insurance provider dedicated to delivering high-quality health coverage and services to help members of all ages maintain and improve their health, located in NE Minneapolis. The individual in this role will be responsible for entering, updating and maintaining provider data in Provider Relations and Contracting (PRC) databases. This is a long-term contract position with the potential to be hired on.

Duties

  • Setup and update Standard & Non-Standard Contracts in PRC databases, including contracted entity and site location changes. Generate unilateral amendments to the contract, audit database set up and compare contractual obligations as listed in the provider contract document.
  • Use Amisys and Cactus to ensure entities and site locations are correct and accurate.
  • Use Medicaid verification and OIG Exclusion verification systems prior to set up of new entities or ownership changes to ensure that they do not have any sanctions against them.
  • Use National Plan & Provider Enumeration system prior to setup to ensure NPI?s are valid.
  • Participate with internal and external committees and PRC database user groups in collaboration with manager. Keep manager informed of changes that will impact the company. Research and recommend methods to improve or implement necessary changes in a prompt and efficient manner
  • Participate in and maintain long term projects to increase the efficiency and accuracy of the data in PRC databases.
  • Assist with the completion of large scale contracted entity and site level updates as needed.
  • Daily external provider contact via emails and phone calls.
  • Daily internal customer issues and concerns via service forms, emails and phone calls.
  • Ensure department turnaround time guidelines are met and accurate.
  • Other projects and duties as assigned.

Requirements

Education and Experience

  • Two year degree or equivalent in computer systems & technology preferred.
  • Demonstrated experience may be considered in lieu of degree.
  • Two or more years of experience in a managed health care environment.
  • Must possess working knowledge of managed care operations.
  • Advanced PC experience.
Preferred
  • Experience as a Systems or Business Analyst.
  • System knowledge of Amisys software.
  • System knowledge of Maccess (EXP) software.
  • System knowledge of Cactus software.
  • Microsoft Office Excel experience.
  • System knowledge of SharePoint.
  • System knowledge of Medicaid Verification and OIG Exclusion verification.
  • System knowledge of National Plan & Provider Numerations.

Post Date: 01.11.2019

Salary: Contact for Rate

Shift: 1st

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If you would prefer to speak directly to a Humera Staffing Consultant, please call us at 612-977-1440 and reference OrderID 816333


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For more than 45 years you may have known us as Dolphin Staffing - a name synonymous with quality temporary, and direct hire employment in the Minnesota. Today we are Humera - a boutique staffing agency that specializes in the placement of the best and brightest administrative and professional talent for contract, contract to hire and direct hire opportunities. Although we have changed our name, we continue to provide flexible career opportunities across a broad range of industries and with companies large and small. We invite you to become part of our elite workforce today!

Humera Administrative and Professional Staffing is an Equal Opportunity Employer.