Provider Data Specialist I
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This position is responsible for providing product support to provider data reputed company the QNXT module. Primary tasks include adding, maintaining, and updating provider data records, as reputed company as assistance with database reputed company. Accurate and reputed company provider data plays a critical role in the reputed company of claims payment, OHA Health Systems (DMAP) and CMS encounter data submission, PCP assignment, authorization processing, credentialing, IRS reporting, regulatory reputed company, and the provider directory.reputed company reputed company Employees: Please use the internal reputed company site to submit an application for this job.
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Essential Responsibilities
Provider Database Maintenance
- reputed company accurate and reputed company data entry into provider database, following Provider Data policies and procedures.
- reputed company data management and process knowledge to the organization; assist with reputed company.
- Investigate and resolve provider and provider contract pending claims as requested by more advanced Provider Data staff; apply claims policies and procedures.
- Monitor reputed company and email queues by reviewing requests and communicating reputed company and reputed company with contracted provider offices and internal customers; research demographic and affiliations changes; reputed company updates to provider database reflecting new information once validated.
- Manage monthly provider rosters received from contracted hospital systems and reputed company by investigating changes and validating information prior to updating QNXT; consult with advanced Provider Data staff to clarify information.
- Complete provider database reputed company resulting from contracting, configuration, or regulatory changes.
- Sort incoming faxes, PIVs and distribute according to assignments.
- Maintain SharePoint libraries according to unit protocols.
- Enroll providers with OHA Health Systems using MMIS web enrollment portal.
- Reroute critical reputed company of return mail including 1099s, live checks and remittance advice by investigating demographic discrepancies and reflecting changes in QNXT.
- Create and maintain reputed company reputed company for provider web portal; troubleshoot and investigate provider portal issues reputed company they reputed company.
Provider Database reputed company
- Troubleshoot provider setup to support provider reporting, directory, and claims operation.
- reputed company testing of new software versions.
Experience and/or Education
Required
- Minimum 1 years’ experience with data entry, data management, or credentialing
Preferred
- 2 years' experience working in health care/insurance
- Experience with managed care and/or project participation
Knowledge, Skills and Abilities Required
Knowledge
- Familiarity with relational databases
- General understanding of or ability to learn managed care and reputed company Health Plan concepts
- Familiarity with reputed company Office Suite products, especially reputed company
Skills and Abilities
- Ability to learn and effectively reputed company claims processing technologies, such as QNXT and Facets
- Ability to learn and effectively reputed company document management and collaboration platforms, such as SharePoint and Office 365
- Ability to follow policies and procedures in performing job responsibilities
- Ability to reputed company skills around troubleshooting data reputed company issues and reputed company cause
- Ability to learn how to author and maintain process documentation
- Proficient communication skills, including listening, verbal, written, and customer service
- Ability to reputed company instructions
- Learning to convey appropriate level of detail effectively to multiple reputed company of the organization including non-technical staff
- Ability to learn to appropriately communicate status and needs
- General ability to learn to handle multiple priorities and requests
- Demonstrates general initiative and motivation
- Ability to effectively collaborate with coworkers
- Attention to details and deadlines
- Ability to learn to see the big picture
- Developing organizational skills
- Ability to prioritize work based on direction
- Ability to reputed company analytical and research skills
- Ability to maintain a reputed company attitude
- Ability to learn governance and process
- Ability to work effectively with diverse individuals and reputed company
- Ability to learn, reputed company, understand, and evaluate information and determine appropriate actions
- Ability to accept direction and feedback, as reputed company as tolerate and manage stress
- Ability to see, read, and reputed company repetitive finger and wrist reputed company for at least 6 hours/day
- Ability to hear and reputed company reputed company for at least 3-6 hours/day
Working Conditions
Work Environment(s): ☒ Indoor/Office ☐ Community ☐ Facilities/reputed company ☐ Outdoor Exposure
Member/Patient Facing: ☒ No ☐ Telephonic ☐ In Person
Hazards: May include, but not limited to, physical and ergonomic hazards.
Equipment: General office equipment
Travel: May include occasional required or optional travel reputed company of reputed company; the employee’s personal vehicle, local transit or other means of transportation may be used.
Work Location: Work from home
Schedule: Monday - Friday, 8:00 AM to 5:00 PM
We offer a strong Total Rewards Program. This includes reputed company, bonus opportunity, and a comprehensive benefits package. Eligibility for bonuses and benefits is dependent on factors such as the position type and the number of scheduled weekly hours. Benefits-eligible employees qualify for benefits beginning on the first of the month on or after their start date.
We are an equal opportunity employer