Job ID: 2 Type: Full-Time/Regular # of Openings: 1 Category: Public Health Karna
The Provider Network Analyst will work in support of the World Trade Center Health Program (WTCHP) client providing expert support, education and knowledge to internal and external contracted providers, Clinical Centers of Excellence (CCE ) staff, Karna staff/colleagues, and others as required.
*position is contingent on contract award*
Provides expert support, analysis and research into complex problems and processes relating to the World Trade Center Health Program (WTCHP)Responsible for educating new providers on all WTCHP policies and proceduresResponsible for researching and answering provider inquiries regarding Fee Schedules and/or ReimbursementWorks closely with other department staff and escalates issues as needed to senior level SMEWorks with CCE Case Managers to assist with referrals to network providers (assists in locating the closest provider based on specialty and where patient resides/works)Provider and CCE Outreach to include, but not limited to, the following:Obtain updated demographic information when RAs are returned due to invalid addressesClarify vendor NPI setupsValidate incorrect NPIsGather information about claims paymentsObtain updated EFT information when payments fail due to invalid bank account informationProcess provider information into to send to claims subcontractor for entry into their claims system and portalOther duties as assigned Qualifications
Requires at least five (5) years of relevant experienceBachelor's degree preferred; equivalent experience in lieu of degree Well-versed in Microsoft Office products to include Word, Excel, PowerPoint and Outlook.Knowledge of various provider reimbursement types to include FECA, DRG, Cost to Charge Ratio (CCR) is requiredStrong verbal and written communication skills and the ability to interact effectively with a diverse group of staff, both internal and external, and providers