ADMINISTRATION REPRESENTATIVE
JOB DESCRIPTION FOR:
PNA ADMINISTRATION REPRESENTATIVE
PROVIDER ADMINISTRATION
AUSTIN, TEXAS
The following job description is a general outline of essential and common functions related to the performance of your job. All employees of USA Quality Staffing, Inc. are expected as a condition of employment to perform tasks as assigned by management whether included in your job description or not.
Supervisor
Director Provider Administration
Job Classifications for EEOC (check applicable boxes)
1. Exempt or Non-Exempt
2. Officials/Manager Professional Technician
Sales Worker Office/Clerical Laborer
Service Worker
Job Summary
Responsible for credentialing all incoming physician agreements and responsible for processing network updates for the IPA division of the Provider Administration department. Various departmental projects as assigned.
Key Responsibilities (list specific job duties)
Credential direct provider agreements following the required guidelines within the required turnaround time frame.
Perform Primary Source verifications, state license verifications and/or Hospital Privileges verification on all incoming direct provider agreements. Additional verifications are also performed on specific states.
Query National Practitioner Data Bank and identify those agreements needing the attention of the Medical Review Committee.
Performs Quality Control verifications on Pended and Non-Pended Claims.
Communicate with providers and facilities written or verbal regarding various questions or contractual issues.
Assist with the Provider Administration Departmental Queue Line to answer contracting questions from providers or facilities.
Process updates for directly contracted providers utilizing Word, Excel, and other acceptable update formats.
Process updates for IPA Networks utilizing Word, Excel, and other acceptable update formats. (Data Entry)
Communicate with IPA Network’s contacts by email, phone, or fax regarding update questions or clarifications.
Log and save all incoming direct and IPA Network updates by utilizing the Microsoft Outlook program.
Multi-task on several departmental projects.
Process various time sensitive projects as assigned.
Cross train on departmental tasks.
Maintain daily production reports.
At various times back up for Customer Care Calls utilized SO2 call tracking system.
Adhere to the USA Managed Care Organization’s information Security Policies and Procedures.
Adhere to HIPPA Guidelines and Requirements.
Level I
● ____________________________
● Minimum of 2years in an administrative capacity.
● High school graduate of equivalent.
Level II
● _____________________________
● 3+ years in an administrative capacity.
● High school graduate of equivalent.
Level III
● _____________________________
● 5+ years in an administrative capacity in the healthcare industry preferred.
Qualifications/Skill Requirements
Typing 30 wpm
10-key Y Y or N