Job Details

Provider Information Specialist I

NTT DATA strives to hire exceptional, innovative and passionate individuals who want to grow with us. If you want to be part of an inclusive, adaptable, and forward-thinking organization, apply now.

We are currently seeking a Provider Information Specialist I to join our team in Baton Rouge, Louisiana (US-LA), United States (US).

Summary: Compile appropriate information to make requested credentialing, contractual, and demographic updates and changes related to provider data in the systems of record in an accurate, complete and timely manner. Manage and sustain positive provider relationships. Setup providers and networks in systems of record, assign provider numbers and communicate with provider community. Facilitate accurate financial claims payment and provider directory processes. Represent BCBSLA to external provider communities and internal stakeholder groups.

Job Duties:

• Accurately setups providers in provider systems of record to ensure appropriate claims payment in accordance with contractual language.
• Compiles, analyzes, and verifies the required information for provider enrollment, contracts, and maintenance for completeness and accuracy, and enter it into the systems of record.
• Communicates, orally and in writing, directly with providers to resolve questions and issues regarding updates and changes in the systems of record.
• Researches, responds to, analyzes and resolves complex claims issues related to provider setup and provider eligibility on a daily basis.
• Creates resolution documents to address provider issues and increase provider satisfaction. Utilizes probing and problem solving methods to resolve all inquiries/requests. Identifies, understands and anticipates providers unexpressed needs and concerns.
• Provides cross functional support and serves as subject matter resource or second tier resolution to internal and external provider teams (i.e., Contracting, Provider Relations, etc).
• Manage timely responses to external provider inquiries and requests. Evaluate new service requests from providers to determine appropriate actions for recording into the systems of record.
• Recommend, and participate in process improvement opportunities for Network Management Operations.
• Identify system problems, gaps or inconsistencies in workflows and/or processes. Recommend appropriate updates, alternatives and solutions.
• Accountable for complying with all laws and regulations associated with duties and responsibilities.

Required skills

• Two years of customer service, credentialing, enrollment and billing, claims and/or insurance operations experience is required.
• One year experience in of insurance services and operations.
• High School diploma or equivalent is required. Prefer an Associate or Bachelor's degree in business or health related field

Hiring Preferences

• Facets, IPD, Provider Manager, and Cactus knowledge preferred.
• Prior claims processing experience preferred.
• Strong analytical skills/problem solving skills.
• Critical thinking/ability to question.
• Provider (customer) focused.
• Interpersonal skills/relationship building.
• Excellent communication skills with internal and external stakeholders; ability to effectively communicate with provider community in a professional manner.
• Ability to multitask in a fast-paced production environment.
• Strong organizational skills/Time management.
• Takes accountability for work performed.
• Ability to work both individually and in a team environment with shared goals.
• Ability to work under pressure to produce high quality work with defined turnaround goals.
• Ability to effectively adapt to change.

About NTT DATA

NTT DATA is a $30 billion business and technology services leader, serving 75% of the Fortune Global 100. We are committed to accelerating client success and positively impacting society through responsible innovation. We are one of the world's leading AI and digital infrastructure providers, with unmatched capabilities in enterprise-scale AI, cloud, security, connectivity, data centers and application services. Our consulting and Industry solutions help organizations and society move confidently and sustainably into the digital future. As a Global Top Employer, we have experts in more than 50 countries. We also offer clients access to a robust ecosystem of innovation centers as well as established and start-up partners. NTT DATA is a part of NTT Group, which invests over $3 billion each year in R&D.

Whenever possible, we hire locally to NTT DATA offices or client sites. This ensures we can provide timely and effective support tailored to each client's needs. While many positions offer remote or hybrid work options, these arrangements are subject to change based on client requirements. For employees near an NTT DATA office or client site, in-office attendance may be required for meetings or events, depending on business needs. At NTT DATA, we are committed to staying flexible and meeting the evolving needs of both our clients and employees.