About this role
Provider File Maintenance (PFM) Specialist
Location: Birmingham, AL
Work Schedule: Mostly Remote - after an onsite training period at our downtown Birmingham office, this position can transition to work mostly remote, with occasional onsite days. The successful candidate must reside within a reasonable travel distance of Birmingham.
Why VIVA HEALTH?
VIVA HEALTH, part of the renowned University of Alabama at Birmingham (UAB) Health System, is a health maintenance organization providing quality, accessible health care. Our employees are a part of the communities they serve and proudly partner with members on their healthcare journeys.
VIVA HEALTH has been recognized by Centers for Medicare & Medicaid Services (CMS) as a high-performing health plan and has been repeatedly ranked as one of the nation's Best Places to Work by Modern Healthcare.
Benefits
• Comprehensive Health, Vision, and Dental Coverage
• 401(k) Savings Plan with company match and immediate vesting
• Paid Time Off (PTO)
• 9 Paid Holidays annually plus a Floating Holiday to use as you choose
• Tuition Assistance
• Flexible Spending Accounts
• Healthcare Reimbursement Account
• Paid Parental Leave
• Community Service Time Off
• Life Insurance and Disability Coverage
• Employee Wellness Program
• Training and Development Programs to develop new skills and reach career goals
• Employee Assistance Program
See more about the benefits of working at Viva Health - https://www.vivahealth.com/careers/benefits
Job Description
The Provider File Maintenance (PFM) Specialist is responsible for maintaining accurate provider demographic, payment, and contractual information in VIVA HEALTH'S claims processing system.
Key Responsibilities
• Enter and update providers in VIVA HEALTH'S claims processing system.
• Verify integrity of data by comparing it to source documents. Review input data for errors or missing information and resolves any discrepancies.
• Monitor and maintain Medicare opted-out providers and Medicare precluded providers.
• Communicate terminated and reinstated providers to all areas of VIVA HEALTH.
• Perform fee schedule maintenance in the claims processing system. Support the configuration team, as needed, in maintaining system reference files.
REQUIRED QUALIFICATIONS:
• High School Diploma or GED
• Healthcare industry knowledge
• Ability to work under pressure to meet deadlines with minimal supervision
• Demonstrate excellent customer service skills through written and verbal communication
• Ability to produce quality-focused work
• Ability to work independently and as a member of a team
• Basic computer skills
PREFERRED QUALIFICATIONS:
• Some College
• Claims processing and/or provider credentialing/contracting knowledge
• 2 – 3 years' experience with PowerSTEPP
• Proficient knowledge of Microsoft Excel and Microsoft Outlook