AIDS Healthcare Foundation

Returning Candidate?

Provider Relations Data Entry Clerk

Provider Relations Data Entry Clerk

Req No 
2017-6854
Job Locations 
US-FL-Ft. Lauderdale
Category 
Managed Care
Type 
Regular Full-Time

More information about this job

WHO WE ARE

Positive Healthcare, AIDS Healthcare Foundation's Managed Care Division, has provided people living with HIV quality health care since 1995 when it started the nation’s first Medicaid health plan for HIV-positive people living in Los Angeles. Today, Positive Healthcare cares for more than 7,000 lives in California and Florida.

 

PHP (HMO SNP)

PHP is a Medicare Advantage Prescription Drug health plan specifically for Medicare beneficiaries who are living with HIV and reside in Duval, Broward and Miami-Dade Counties.

PHP is the first HIV-specific special needs health plan approved by the Centers for Medicare & Medicaid Services (CMS). This plan covers routine doctor and specialist office visits, emergency and urgent care, hospitalization, and more. It also includes a prescription drug benefit for no monthly premium.

 

PHC Florida

PHC Florida is a Medicaid managed care plan designed specifically for HIV-positive individuals who are eligible for Medicaid and live in Broward, Miami-Dade and Monroe Counties.  PHC Florida is a Managed Medical Assitance (MMA) plan offered through Florida’s statewide Medicaid Managed Care Program

YOUR CONTRIBUTION TO OUR SUCCESS!

The Provider Relations Coordinator is responsible for projecting and integrating the Mission and Core Values of the organization within and outside of the Managed Care Department.

Essential Duties & Responsibilities
Includes the following.  Other duties may be assigned.

  • Support efforts of Provider Relations and Credentialing by ensuring accurate and complete Provider demographics, including all information needed for the acceptance of encounters, provider network files, and enrollment files by AHCA, CMS and DMHC.
  • Responsible for entering initial credentialing, demographic and contract information in PHP/PHC MIS system for delegated provider groups and non-contracted providers.
  • Responsible for accuracy and completeness of provider information in PHP/PHC MIS system by tracking terminations and additions to provider network and remediating or completing any information needed not included on files supplied by various PHP/PHC network affiliates.
  • Responsible for working with MIS departments on monthly update of provider network files on websites in compliance with CMS and AHCA.
  • Responsible for maintaining current provider files, including incoming/outgoing correspondence.
  • Compares data entered with source documents and re-enters data
  • Makes necessary corrections to information entered
  • Compiles sorts and verifies accuracy of data to be entered
  • Keeps record of work completed
  • Files source documents after entry
  • Responds to inquiries regarding entered data


Supervisory Responsibilities
This job has no supervisory responsibilities.

 

Qualifications
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.    The requirements listed below are representative of the knowledge, skill, and/or ability required.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education and/or Experience
Associate’s degree (A.A.) or relevant experience in data management and customer service.
 
Other Skills & Abilities/Qualifications
Ability to summarize analytical results in Crystal Reports, MS Excel, PowerPoint, etc.   
Proficient and demonstrated use of database reporting tools for data manipulation, data extraction, merging of large, complex data from variety of sources.
Prior experience with health-related databases and electronic medical records systems preferred.
Typing:  50 words per minute (minimum)
Provider claim processing knowledge and/or experience is preferred.

 

We at AIDS Healthcare Foundation believe that each individual is entitled to equal employment opportunities without regard to race, color, creed, gender, sexual orientation, gender identity, marital status, national origin, age, veteran status or disability. The right of equal employment opportunity extends to recruiting, hiring selection, transfer, promotion, training and all other conditions of employment.