Claims, Audit and Recovery
Provider Configuration Specialist
Chicago, IL, United States
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Your Future Evolves Here

Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving force that brings us to work each day. We believe in embracing new ideas, challenging ourselves and failing forward. We respect and celebrate individual talents and team wins. We have fun while working hard and Evolenteers often make a difference in everything from scrubs to jeans.

Are we growing? Absolutely—56.7% in year-over-year revenue growth in 2016. Are we recognized? Definitely. We have been named one of “Becker’s 150 Great Places to Work in Healthcare” in 2016 and 2017, and one of the “50 Great Places to Work” in 2017 by Washingtonian, and our CEO was number one on Glassdoor’s 2015 Highest-Rated CEOs for Small and Medium Companies. If you’re looking for a place where your work can be personally and professionally rewarding, don’t just join a company with a mission. Join a mission with a company behind it.


What You'll Be Doing:

This position is responsible for status reporting and coordination for day to day work for their client team including issue escalation and confirmation of team priorities.

  • Maintenance of provider data within claims processing system including managing credentialing variables and demographics (credentialed and non-credentialed providers), contract or fee schedule assignment and network affiliation based on weekly provider files submitted by clients
  • Work and troubleshoot claims that suspend in work queues for lack of provider match in the claims processing system. This includes working with IT and necessary members of management to increase auto adjudication of claims by seeking alternatives to current workflows
  • Researching NPI numbers and gather similar licensure data on providers entered into the claims processing system to ensure each provider is appropriately loaded
  • Participation in problem solving of the monthly 837 Encounter File submissions and error corrections (if applicable)
  • Auditing provider demographics pre-payment cycle to ensure accuracy
  • Other duties related to system and report data integrity
  • Maintain upward communication with leadership regarding development within areas of assigned responsibilities and perform special projects as required or requested.
  • Provide insight and share best practices that can be reusable across teams with the Line of Business or Department or escalate issues that may impact other teams or lines of business
  • Comply with HIPAA, and all internal policies and other corporate and departmental policies.
  • Maintain complete confidentiality of company business.
Job Requirements:
  • Ability to represent the department effectively with supporting teams
  • Demonstrate problem solving, critical thinking, and process analysis skills to support teams responsible for client configuration
  • Possess willingness to learn and develop understanding of configuration best practices.
  • Willingness to escalate issues that may impact team productivity or confusion on priorities
     

Evolent Health is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, or national origin.

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