Provider Data Specialist

Job Summary

Applicants must live in Arizona and metro areas

Ensures accurate, timely maintenance and synchronization of critical provider data across all provider databases, and systems.

Accesses and utilizes multiple software applications. Applies business rules and knowledge of Provider contract language, pricing and reimbursement methodologies to each database / system to validate Provider information across systems.

Communicates with internal and external clients by phone and email to clarify data and follow-up on issues, while working under timeline, accuracy and production targets.

Requires the ability to manage a large amount of complex information and must be able to communicate clearly and draw sound conclusions.

Supports the maintenance of accurate, up-to-date provider data to include updates, changes, additions and terminations for assigned files.

Education & Experience

Required :

• High School Diploma or GED
• 2 years of varied responsible experience with computer database programs

Preferred :

• 2 years data entry experience
• Experience using Provider Data Management Systems or Provider Data Management Systems

Key Responsibilities

• Process provider data inventory within expected timeline while meeting accuracy and production targets.
• Identify, research, and analyze issues received to determine appropriate handling. Resolve provider data correction requests in a specified time frame.

Manage daily follow up of Provider data correction requests and resolve all issues to ensure databases are current and accurate.

• Maintains and processes reimbursement terms to ensure correct claims payment and downstream processing.
• Review Provider contract language and identify when the contract is out of compliance. Process Provider contracts, run reports and respond to inquiries regarding contract compliance issues;

image and index contracts and return images to network subcontractors. Conduct quality assurance activities to ensure image quality and completion of image activities.

• Supports requests for assistance and researches issues using various resources including online searches and phone calls.
• Communicates clearly through both written and verbal forms of communication and follows up with various parties to ensure tasks are completed within the allotted timeline or issues are escalated appropriately.
• Coordinate with internal departments for provider database related issues.
• Perform all other related duties as assigned by supervisor
• Regular and reliable attendance is required.

Competencies

Commitment to Task : Ability to conform to established policies and procedures; exhibit high motivation.

Communication / People Skills : Ability to influence or persuade others under positive or negative circumstances; Adapt to unique styles;

Listen critically; Collaborate.

Computer Literacy : Ability to function in a multi-system Microsoft environment using Word, Excel, Outlook, TriWest Intranet, the Internet, and department software applications.

Organizational Skills : Ability to multi-task, adjust to priorities and learn new systems, within the time constraints and with available resources;

must be detail-oriented.

Problem Solving / Analysis : Ability to solve problems through systematic analysis of processes with sound judgment; Has a realistic understanding of relevant issues.

Technical Skills : Proficient with key databases, including FoxPro, Claims Systems, Medical Management Systems, and Provider Data Management Systems;

working knowledge of VA policies and procedures, current knowledge of claims, reimbursement methodology; healthcare or managed care experience.