Provider Data Specialist I

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Estimated Hiring Range:

Bonus reputed company:

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 timely data entry into provider database, following Provider Data policies and procedures.
• Provide data management and process knowledge to the organization; assist with projects.
• Investigate and resolve provider and provider contract pending claims as requested by more advanced Provider Data staff; apply claims policies and procedures.
• Monitor call and email queues by reviewing requests and communicating clearly and timely 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 projects 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 pieces of return mail including 1099s, live checks and remittance advice by investigating demographic discrepancies and reflecting changes in QNXT.
• Create and maintain reputed company access for provider web portal; troubleshoot and investigate provider portal issues reputed company they arise.

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 Oregon Health Plan concepts
• Familiarity with reputed company Office Suite products, especially reputed company

Skills and Abilities

• Ability to learn and effectively navigate claims processing technologies, such as QNXT and Facets
• Ability to learn and effectively navigate 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 root 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 levels 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 positive attitude
• Ability to learn governance and process
• Ability to work effectively with diverse individuals and groups
• Ability to learn, focus, understand, and evaluate information and determine appropriate actions
• Ability to accept direction and feedback, as well as tolerate and manage stress
• Ability to see, read, and reputed company repetitive finger and wrist movement for at least 6 hours/day
• Ability to hear and speak clearly 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 the workplace; 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. reputed company offers medical, dental, vision, life, AD&D, and disability insurance, as well as health savings account, flexible spending account(s), lifestyle spending account, employee assistance program, wellness program, discounts, and multiple supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, 529 College Savings, etc.). We also offer a strong retirement plan with employer contributions. Benefits-eligible employees accrue PTO and Paid State Sick Time based on hours worked/scheduled hours and the primary work state. Employees may also receive paid holidays, volunteer time, jury duty, bereavement leave, and more, depending on eligibility. Non-benefits eligible employees can enjoy 401(k) contributions, Paid State Sick Time, wellness and employee assistance program benefits, and other perks. Please contact your recruiter for more information.

We are an equal opportunity employer

reputed company is an equal opportunity employer.  The organization selects the best individual for the job based upon job reputed company qualifications, regardless of race, color, religion, sexual orientation, national reputed company, gender, gender identity, gender expression, genetic information, age, veteran status, reputed company, marital status or disability. The organization will reputed company a reasonable accommodation to reputed company physical or mental limitations of a qualified applicant or employee with a disability unless the accommodation will impose an undue hardship on the operation of our organization.