Network Data Specialist

Banner Health•Mesa, AZ

1d•Remote

About The Position

Banner Plans & Networks (BPN) is a nationally recognized healthcare leader that integrates Medicare and private health plans. Our main goal is to reduce healthcare costs while keeping our members in optimal health. BPN is known for its innovative, collaborative, and team-oriented approach to healthcare. We offer diverse career opportunities, from entry-level to leadership positions, and extend our innovation to employment settings by including remote and hybrid opportunities. As a Network Data Specialist for Banner Plans & Networks, you will be part of the Provider Data Management Team. You will call upon your provider management and IDX application experience to enter provider information into Provider Manager for claims payments to be made. Prior work experience in provider network planning, process management, or healthcare operations experience is highly preferred. Your work location will be entirely remote. Your work 8 hour shifts will be Monday-Friday working in business hours in the Arizona Time Zone. If this role sounds like the one for you, Apply Today! This is a fully remote position and available if you live in the following states only: AZ, CA, CO, NE, NV, and WY. With this remote work, candidates must be self-motivated, possess moderate to strong tech skills and be able to meet daily and weekly productivity metrics. Banner Plans & Networks (BPN) is an accountable care organization that joins Arizona's largest health care provider, Banner Health, and an extensive network of primary care and specialty physicians to provide the most comprehensive healthcare solutions for Maricopa County and parts of Pinal County. Through BPN, known nationally as an innovative leader in new health care models, insurance plans and physicians are coming together to work collaboratively to keep members in optimal health, while reducing costs. POSITION SUMMARY This position provides file maintenance of the provider database. Ensures accuracy of high volume data and maintenance of provider demographic and contract files. Interprets provider contractual language and interprets guidelines. Maintains proper record keeping of all system support files.

Requirements

Strong knowledge and understanding of healthcare planning as normally demonstrated through a minimum of one year of provider network planning and/or process management or operations experience.
Requires strong Excel knowledge, ability to analyze statistical data, and the ability to work on a variety of projects in an organized fashion.
Must possess a strong knowledge of business and/or healthcare as normally obtained through provider relations experience or healthcare provider file maintenance experience.
Must have an understanding of managed care reimbursement strategies and methodologies for physicians, hospitals and ancillary providers.
Must be able to communicate effectively with others by speaking, reading, and writing.

Nice To Haves

Bachelor’s degree in business, healthcare administration, or related field.
One year of medical claims auditing and or provider data demographic processing experience and an understanding of medical terminology and knowledge of CPT-4 and ICD-9 coding.
Additional related education and/or experience preferred.
Provider management and IDX application experience
Prior work experience in provider network planning, process management, or healthcare operations experience
Moderate to strong tech skills
Self-motivated

Responsibilities

Maintains current and validated provider demographics, networks, tax identification, 1099 data, Medicare certification and NPI data in the system with a high level of accuracy and meeting minimum productivity requirements.
Provides information to appropriate personnel in regard to changes and updates in system support files.
Assist in education of providers, hospitals and the internal and external staff on demographic and network data requirements.
Identifies, assists, and resolves managed care issues concerning claims, contract interpretation, eligibility and general provider demographic operational issues.
May communicate with network providers and staff and inform them of any operational, procedural, and contractual changes and updates.
Assists internal departments in resolving provider and member appeals pertaining to the physician, ancillary providers and hospital network arrangements and plan contracts.
Maintains accurate and current provider information and provides system support in provider network development.
Assists with reporting network development needs in various geographic regions. Completes managed care contracts updates in the Impact system for payors and providers. Creates and processes required provider statistics and reporting.
Assists in the system development and maintenance for a designated comprehensive provider network of physicians and hospitals. Under limited supervision, responds to and resolves issues related to the daily administration of demographic data for potential and existing providers and non-contracted providers. Customers may include Network Providers, Payors, Physicians and internal Provider Relations and Claims Reimbursement team members.