Process Executive at Cognizant in Plano, Texas

Job Description:

Cognizant looking for Process Executive - Texas

Responsibility:

Responsibilities:

• Responsible for timely and accurate maintenance of provider records in Provider System.


• Data entry of updates/additional information in provider source system after due verification.


• Receive and update new provider records and providers changes in the source system within accepted productivity and quality guidelines.


• Research missing information on provider records by contacting provider relations managers, delegate groups and vendors.


• Research, update and reconcile provider requests to support claims operations, customer service, membership and other functions.


• Triage and resolve claims pended due to provider configuration issues.


• Track and escalate issues, coordinate with supervisors to resolve and document the details.


• Update and maintain process DLP’s, checklists and other documentations critical to process and any ongoing process changes.

Skills/Experience:

• The ideal candidate will possess a high school diploma (two years of college preferred)


• Preferred to have 1+ year of experience in a health plan set up and provider operations


• Understanding of provider data, type of providers, par vs non-par classification, credentialing process, contracts and provider fee schedules.


• Understanding of claims operations and relevance of provider data to enable accurate adjudication of claims.


• Ability to research, compare data and make decisions based on findings and process requirements.


• Basic knowledge of Microsoft Office applications (Excel, Word, Outlook etc.)


• Ability to work independently and communicate effectively.


• High school diploma or equivalent.

Domain Skills

* Proficiency Legends