OR - Provider Technical Spec - Senior - Remote

DEPARTMENT DESCRIPTION Samaritan Health Plans (SHP) operates a portfolio of health plan products under several different legal structures:
Inter Community Health Plans, Inc. (IHN) is designated as a regional Coordinated Care Organization (CCO) for Medicaid beneficiaries;
Samaritan Health Plans, Inc. offers Medicare Advantage, Commercial Large Group, and Commercial Large Group PPO and EPO plans; SHP is also the third-party administrator for Samaritan Health Services' self-funded employee health benefit plan. As part of an Integrated Delivery System, Samaritan Health Plans is strategically and operationally aligned with Samaritan Health Services' mission of Building Healthier Communities Together EXPERIENCE/EDUCATION/QUALIFICATIONS Associate's degree or equivalent experience required.

Two (2) years experience in Provider Services required. Two (2) years experience in Health Plan Insurance Plans required. Previous Facets experience required. Previous claims experience preferred.
• Experience in provider data healthcare
• Provider data entry experience
• Experience in documenting processes, creating workflows and policies
• Knowledge of compliance requirements and procedures preferred
• Critical and analytical thinking skills
• Project implementation preferred
• Experience in Facets, or similar provider data or claims processing system
• Experience in other provider related healthcare departments such as credentialing, provider relations or contracting preferred

Experience with Provider Lenz preferred

Shift: Days ) occasional weekends

Specialty Type:
Clerical

Sub Specialties:
Data Quality Specialist, Medical Staff Coordinator
General

Certifications:

N/A
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