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Job Summary

According to established departmental policies, procedures and standards, the position is responsible for the accuracy and integrity of the Corporation's TPA and PPO Provider and Vendor files. The position is also responsible for the research and resolution of claims issues as they relate to internal/external contracting, pricing, and claims administration.

Main Duties

  • Accurate and timely loading and testing of hospitals, physicians, dental, and other contracts according to established productivity benchmarks.
  • Responsible for the accuracy and integrity of the Provider and Vendor Files, including the ongoing audit of provider information in multiple systems.
  • Investigate and resolve provider file inaccuracies and discrepancies, coordinating with other FCH departments as necessary.
  • Maintain standards for claims and contact services forms turnaround timelines for Provider File investigation suspense.
  • Utilize multiple Oracle Databases including Bridge and Diamond.
  • Utilize other software programs including InfoMaker, Crystal, Excel and First Choice Health websites on a daily basis to aid in researching and resolving provider issues.
  • Respond to Provider file problems or questions in an effective and timely manner.
  • Maintain department metric reporting, staffing analysis, TPA metrics, PPO metrics and weekly status update.
  • Responsible for the accuracy and integrity of the Provider and Vendor files.
  • Respond to Provider file problems or questions in an effective and timely manner.
  • Document operational policies and procedures as needed.
  • Identify and document requests for information system enhancements.
  • Perform periodic provider audits to ensure quality and timeliness of provider and fee schedule updates.
  • Coordinate the day to day functions with PPO Reimbursement department to ensure efficient and accurate claim pricing for TPA groups (i.e. Special TPA contracts, Out of State and TPA run in claims).
  • Coordinate with TPA Operation department to administer new TPA group setups for special benefit/pricing packages.
  • Other related duties as assigned.


  • AA degree in Business Administration, High School diploma and 5 years equivalent experience in a healthcare environment.
  • Understand different provider reimbursement methodologies.
  • Advanced computer skills and knowledge. 
  • Proven ability to design and develop reporting.
  • Proven ability to perform difficult analytical tasks with minimum supervision.
  • Strong written, verbal and interpersonal skills. Strong attention to detail and accuracy balanced with the desire to hit deadlines.
  • Ability to work independently and as a member of a team.

Our Benefits

Become a First Choice Health employee and enjoy our generous benefit package. We offer competitive benefits that are much beyond the traditional basics.

Click here to learn more about our competitive benefit package.

How to Apply

Please submit your resume to

Additional information about our company may be found on our website