Temporary Operations Resolution Specialist MCHP – Provider Data Management remote

Trinity Health • Columbus, OH

11h • Remote

About The Position

The Provider Data Management role manages the integrity of the Health Plan's provider data to maintain compliance with Federal and local requirements. This position must have knowledge and competence in regulatory requirements for the Health Plan's provider data while maintaining confidentiality and use of discretionary discernment with sensitive materials. Serves as department subject matter expert requiring knowledge of plan systems, tools, policies and procedures and acts as liaison with internal and external customers. The role will conduct audits to ensure compliance with the Centers for Medicaid and Medicaid Services (CMS) requirements. Additionally, the role will be expected to produce accurate reports of the plan's provider data as required by CMS for HEDIS purposes. The ORS-Provider Data Management role will be responsible for identification of root causes regarding any discrepancies found in the provider data while working alongside all other Operations Resolution Specialists across the plan to fully resolve issues.

Requirements

• Effective Communication Skills.
• Strong written and verbal communication skills in order to communicate in clear, concise terms to internal and external customer.
• Analytical and problem-solving skills.
• Experience in use of computer systems and office automation applications.
• Knowledgeable with provider credentialing and contracting terminology.
• Basic knowledge of healthcare claims process.

Nice To Haves

• Associate or Bachelor’s degree preferred.
• One to three years experience preferred in either managed care health insurance.

Responsibilities

• Preparation of all initial direct and delegated credentialing rosters for automated Provider Data Load (PDL) process
• Process rejection reports from PDL process and correct any errors discovered
• Education of CIN, groups, etc. for future expansion regarding direct and delegated roster formats to ensure accurate PDL
• Internal audit (monitoring) of Provider Data, such as demographic changes, TIN adds, provider terms, etc.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree
• Number of Employees: 501-1,000 employees