Job description
Join Our Team: Do Meaningful Work and Improve People’s Lives
Our purpose, to improve customers’ lives by making healthcare work better, is far from ordinary. And so are our employees. Working at Premera means you have the opportunity to drive real change by transforming healthcare.
To better serve our customers, we’re creating a culture that promotes employee growth, collaborative innovation, and inspired leadership.
Forbes ranked Premera among America’s 2022 Best Midsize Employers
because we are committed to creating an environment where employees can do their best work and where best-in-class talent comes, stays, and thrives!
COVID-19 Vaccination Policy:
To learn more about our COVID-19 vaccination and accommodation requirements, please visit our Careers landing page.
The Provider Network Specialist is responsible for maintenance of all professional and institutional providers, including national network provider information within the provider source systems and other applicable systems. Research and updates provider demographic information timely and accurately for directories, provider mailings and claims payment. Acts as a liaison between Premera Blue Cross and its providers.
What you will do:
- Ensure data integrity of provider directories for all markets including all demographic, specialty, credentialing and both contractual and non-network participation.
- Provide timely, accurate, and concise responses to inquiries made by internal departments and providers related to networks, contract information, agreement ids, claims, payment methods, on-line directory, provider mailings, and national networks.
- Research and resolve provider inquiries and complex claims issues relating to provider information by investigation/review within department standards/processes.
- Assure compliance with the National Committee for Quality Assurance (NCQA), Office of the Insurance Commissioner (OIC) and other regulatory agencies/requirements.
- Process incoming provider information updates and contract implementation requests, utilizing different applications and websites (ex. Vendor databases, licensing website) and complete the necessary updates into the provider source system.
- Verify provider information for In Network and Out of Network providers (including but not limited to demographic information, remittance, location address, licensure etc., utilizing applicable resources (ex. Phone, email, vendor databases etc.).
- Coordinate with internal departments, such as Care Management, Claims, Customer Service, and Systems and Reporting to answer questions and resolve provider related problems.
- Assist Customer Service with inquiries and unique provider issues.
- Maintain accurate and complete electronic documentation on all provider correspondence.
- Provide support for Provider Network Executives (PNEs) and Provider Network.
- Provide input on improvements regarding workflow, procedures, or policies and make recommendations to management.
- Complete special projects and other duties as assigned.
What you will bring:
- High School Diploma or GED (Required).
- Three (3) years of experience in a production or customer service environment requiring attention to detailed procedures (Required).
- Associates Degree.
- One-year prior health care and provider information experience; medical office or billing experience.
- Knowledge of other internal department operations or functions that assist in resolution of provider inquiries.
- Experience in working with Microsoft Word and Excel.
What we offer
- Medical, vision and dental coverage
- Life and disability insurance
- Retirement programs (401K employer match and pension plan)
- Wellness incentives, onsite services, a discount program and more
- Tuition assistance for undergraduate and graduate degrees
- Generous Paid Time Off to reenergize
- Free parking
Equal employment opportunity/affirmative action:
Premera is an equal opportunity/affirmative action employer. Premera seeks to attract and retain the most qualified individuals without regard to race, color, religion, sex, national origin, age, disability, marital status, veteran status, gender or gender identity, sexual orientation, genetic information or any other protected characteristic under applicable law.
If you need an accommodation to apply online for positions at Premera, please contact Premera Human Resources via email at careers@premera.com or via phone at 425-918-4785.
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