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PIM Analyst II
Ref No.: 18-12222
Location: Irving, Texas
Start Date / End Date: 10/08/2018 to 04/07/2019
Job Description: Summary: Responsible for gathering, coordinating, and processing of data from the provider network for entry into the Provider Information Management System. Also responsible for development of policies and procedures, tracking of provider data, overseeing projects as requested by Director, Manager, Supervisor or Lead of Provider Network Administration unit. Essential Functions: ¿ Oversees receipt of information from providers for update of information in computer system(s). ¿ Analyzes by applying knowledge and experience to ensure appropriate information has been provided. ¿ Loads and maintains provider information into computer system(s) with attention to detail and accuracy in a timely manner to meet department standards of turnaround time and quality. ¿ Audits loaded provider records for quality and financial accuracy and provides documented feedback. ¿ Assists in configuration issues with Corporate team members. ¿ Assists in training current staff and new hires as necessary. ¿ Assists in system related testing. Knowledge/Skills/Abilities: ¿ Knowledge of Managed Care concepts ¿ Comprehensive understanding of state and regulatory grievance and confidentiality regulations. ¿ Working knowledge of grievance hearing protocols ¿ Computer literacy and proficient in Microsoft Excel and Word ¿ Facilitation and CQI skills/training ¿ Ability to handle confidential material with culturally sensitive discretion and integrity ¿ Attention to logic and detail ¿ Good math and problem solving skills ¿ Excellent organizational skills ¿ Ability to interact well with both internal and external customers ¿ Excellent interpersonal and verbal and written communication skills and public speaking skills ¿ Ability to abide by Client¿s policies ¿ Ability to maintain attendance to support required quality and quantity of work ¿ Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA) ¿ Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customers Required Education: Associate¿s Degree in Business or equivalent experience Required Experience: 2-4 years managed care experience. Claims processing background including coordination of benefits, subrogation, and eligibility criteria.
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