Guardian Life Insurance
Join us for an exciting career with the leading provider of supplemental benefits!
Our Promise
Through skill-building, leadership development and philanthropic opportunities, we provide opportunities to build communities and grow your career, surrounded by diverse colleagues with high ethical standards.
The Encounter Provider Data Specialist is responsible for researching, correcting and updating data relating to Avesis’ network of dental and vision provider information due to encounter responses received from partnered health plans in accordance with policies, procedures, and guidelines as outlined in Avesis contractual agreements and State and Federal Guidelines. We are seeking a self-starter who is fueled by collaboration, able to maintain established performance metrics and contribute to team and departmental standards for quality and production. Our chosen candidate will identify opportunities for process improvements and initiatives, along with providing back up support to other areas of the provider data team.
Essential Job Functions:
- Capability to learn/understand the Avesis’ Provider Network and the information necessary to successfully submit encounter files for all Avesis Government clients.
- Conduct reviews to ensure provider information processed on claims is accurate and in accordance with guidelines.
- Update provider data in Avesis’ systems accurately and timely.
- Handle difficult or non-routine scenarios and special projects.
- Monitor and manage encounter rejections from multiple sources.
- Research, track, and trend issues to improve encounter submission processes.
- Test and implement system changes and updates by working with our IT Department.
- Possess thorough knowledge of State and Federal requirements for providers participating in Medicare and Medicaid contracts.
- Skilled use of Avesis systems and applications for claims adjudication and research of provider data.
- Apply policies and procedures to confirm that providers meet the criteria for payment as indicated in contractual guidelines.
- Attend team meetings related to encounter processing and updates regarding encounter submissions.
- Maintain effective intradepartmental communications through sharing of plans, routinely held departmental meetings, and informal interactions.
- Other duties as assigned.
Requirements:
- Associate’s degree in a related field is preferred; High School Diploma, GED or equivalent, required.
- Prior experience with healthcare provider data entry
- Knowledge of Medicare, Medicaid, and Commercial insurance
- Strong skills using Microsoft applications and other windows-based tools
- Ability to read, write, and communicate at a professional level
- Ability to manage multiple tasks and prioritize work
- Effective time management and organizational skills
- Ability to work overtime as needed
We Offer
- Meaningful and challenging work opportunities to accelerate innovation in a secure and compliant way.
- Competitive compensation package.
- Excellent medical, dental, supplemental health, life and vision coverage for you and your dependents with no wait period.
- Life and disability insurance.
- A great 401(k) with company match.
- Tuition assistance, paid parental leave and backup family care.
- Dynamic, modern work environments that promote collaboration and creativity to develop and empower talent.
- Flexible time off, dress code, and work location policies to balance your work and life in the ways that suit you best.
- Employee Resource Groups that advocate for inclusion and diversity in all that we do.
- Social responsibility in all aspects of our work. We volunteer within our local communities, create educational alliances with colleges, drive a variety of initiatives in sustainability.
Equal Employment Opportunity
At Avsis, We See You. We celebrate differences and are building a culture of inclusivity and diversity. We are proud to be an Equal Employment Opportunity employer that considers all qualified applicants and does not discriminate against any person based on ancestry, age, citizenship, color, creed, disability, familial status, gender, gender expression, gender identity, marital status, military or veteran status, national origin, race, religion, sexual orientation, or any other characteristic. At Avsis, we believe that, to operate at the peak of excellence, our workforce needs to represent a rich mixture of diverse people, all focused on providing a world-class experience for our clients. We focus on recruiting, training and retaining those individuals that share similar goals. Come Dare to be Different at Avsis, where We See You!