Provider Technical Specialist-Senior

Samaritan Health Plans (SHP) provides health insurance options to Samaritan employees, community employers, and Medicare and Medicaid members.

SHP operates a portfolio of health plan products under several different legal structures : InterCommunityHealth Plans, Inc.

IHN) is designated as a regional Coordinated Care Organization (CCO) for Medicaid beneficiaries; Samaritan Health Plans, Inc.

offers Medicare Advantage, Commercial Large Group, and Commercial Large Group PPO and EPO plans; SHP is also the third-party administrator for Samaritan Health Services’ self-funded employee health benefit plan.

As part of an Integrated Delivery System, Samaritan Health Plans is strategically and operationally aligned with Samaritan Health Services’ mission of Building Healthier Communities Together.

This is a remote position in which we are able to employ in the following states : Arizona, Arkansas, Connecticut, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Michigan, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Mexico, North Carolina, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, or Wisconsin

JOB SUMMARY / PURPOSE Serves as a senior technical lead to ensure that provider data is entered and administered properly and in a timely manner.

Responsible for staying current on regulations and compliance issues. Leads the advocation of the PDM data entry process as it applies to cross-functional data support.

Meets regularly with other Provider Services departments to ensure proper workflow development and policies / procedures are maintained.

DEPARTMENT DESCRIPTION Samaritan Health Plans (SHP) operates a portfolio of health plan products under several different legal structures : InterCommunity Health Plans, Inc.

IHN) is designated as a regional Coordinated Care Organization (CCO) for Medicaid beneficiaries; Samaritan Health Plans, Inc.

offers Medicare Advantage, Commercial Large Group, and Commercial Large Group PPO and EPO plans; SHP is also the third-party administrator for Samaritan Health Services’ self-funded employee health benefit plan.

As part of an Integrated Delivery System, Samaritan Health Plans is strategically and operationally aligned with Samaritan Health Services’ mission of Building Healthier Communities Together

EXPERIENCE / EDUCATION / QUALIFICATIONS Associate's degree or equivalent experience required. Two (2) years experience in Provider Services required.

Two (2) years experience in Health Plan Insurance Plans required. Previous Facets experience required. Previous claims experience preferred.

KNOWLEDGE / SKILLS / ABILITIES Effective written and verbal communication skills to perform group presentations, tactfully discuss issues, and listen to and understand concepts, rules and procedures.

Ability to work with all levels within the organization, facilitate communication, and effectively document related activities.

Ability to identify complex problems, review related information, employ creativity and alternative thinking to develop and evaluate options and implement solutions.

PHYSICAL DEMANDS

Rarely

1 - 10% of the time)

Occasionally

11 - 33% of the time)

Frequently

34 - 66% of the time)

Continually

67 100% of the time)

CLIMB - STAIRS

LIFT (Floor to Waist : 0"-36") 0 - 20 Lbs

LIFT (Knee to chest : 24"-54") 0 20 Lbs

LIFT (Waist to Eye : up to 54") 0 - 20 Lbs

CARRY 1-handed, 0 - 20 pounds

BEND FORWARD at waist

KNEEL (on knees)

STAND

WALK LEVEL SURFACE

ROTATE TRUNK Standing

REACH - Upward

PUSH (0 - 20 pounds force)

PULL (0 - 20 pounds force)

CARRY 2-handed, 0 - 20 pounds

ROTATE TRUNK Sitting

REACH - Forward

MANUAL DEXTERITY Hands / wrists

FINGER DEXTERITY

PINCH Fingers

GRASP Hand / Fist