Network Notification Specialist

HealthOne Alliance•Dalton, GA

27d

About The Position

Our mission is to enhance well-being by connecting individuals with vital health resources through a compassionate workforce that embodies the spirit of neighbors helping neighbors. VALUES HealthOne is guided by a cultural framework that embodies our values and drives our decisions. Our PURPOSE is to care for people by connecting them to resources that help protect them in health related situations. To fulfill our purpose, we align our PRIORITIES to ensure each decision we make is ethical, empathetic, economical, and efficient. We care for PEOPLE by being welcoming, authentic, truthful, consistent and humble. We are continuously looking for ways to improve our PROCESS and how we get things done. HealthOne seeks individuals with integrity and heart to embody our values. Whether you’re starting your career or looking to develop additional skills to reach your full potential, HealthOne provides the means to help you achieve your goals. JOB PURPOSE The Network Notification Specialist is responsible for managing and maintaining provider data held within the Company’s provider network software databases (Cactus and our internal claim system).

Requirements

High School Diploma or equivalent
Excellent organizational, project management, prioritization, and time management skills
Experience using Microsoft software including, Excel, Word, and Outlook

Responsibilities

Updates Cactus with any add, changes or terminations of providers (Directly credentialed and Delegated providers)
Updates Out of Network providers within our internal claim system
Updates and manages provider payment preference within our internal claim system
Triages and maps provider claim information within our internal claim system
Pulls updates from Cactus to send weekly to the TPA's
Creates / provides reporting on a weekly / monthly basis or as requested by team or management
Sends fee schedules / rate changes to TPAs as needed
Sends opt-ins and updates to the Medicaid CMOs on a weekly or monthly basis as required by the CMOs
Sends monthly reporting to various contracted entities (i.e., PHS-CI, payer rosters, etc.)
Conducts system audits as part of our internal QA
Maintains online provider directories
Participates in data integrity projects as requested by team or management
Stays involved in every aspect of data maintenance to the system
Maintains regular and predictable attendance
Consistently demonstrates compliance with HIPAA regulations, professional conduct, and ethical practice
Works to encourage and promote Company culture throughout the organization
Other duties as may be assigned