Provider Data Services Specialist

Job Description

REQUIREMENTS

• Demonstrated PC skills, including Microsoft Office products and internet navigation skills.
• 6 months of healthcare experience.

RESPONSIBILITIES

• Maintains the Provider Data (demographic and contractual) for all network and non-network providers. Ensures all provider information is accurately recorded and maintained to provide for proper reimbursement and member access (i.e., directory listings).
• Develops and maintains standards for database integrity, corrective actions, database alignment, and manages communication processes with other departments regarding database improvements.
• Provides support for baseline provider data transactions that cannot be administered automatically through the provider database due to system limitations and/or data integrity issues.
• Performs baseline demographic transaction updates in provider system applications in support of claim adjudication and Provider directory
• Performs intake triage and responds to network inquiries, escalates when necessary.
• Provides on-going department support in research and analysis essential to resolving concerns/issues raised by providers and other internal/external customers.
• Sends requests to individual providers and/or delegated groups to verify information on file and follows up as needed to ensure information is received.
• Conducts audits of provider information and escalates issues for resolution as appropriate.

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