Provider Credentialing & Data Specialist II (Data Entry)

Medical Mutual of Ohio-posted about 1 year ago
Full-time • Entry Level
Remote
1,001-5,000 employees
Insurance Carriers and Related Activities
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The Provider Credentialing & Data Specialist II role involves performing routine to moderately complex data entry and credentialing tasks for practitioners, providers, and organizations within the Provider Data Management System. The position ensures compliance with various standards and meets production and quality metrics while supporting the overall credentialing process.

  • Retrieves applications and/or data from central repositories for provider data.
  • Accesses various external websites, internal matrices, and contacts organizations to verify accuracy of information provided.
  • Identifies whether application and/or document is clean or requires further review and routes to appropriate area.
  • Enters verified data into the Provider Data Management Systems.
  • Identifies eligibility for networks and updates appropriately affecting the accuracy of claim payments and the provider directory.
  • Electronically contacts providers and/or internal departments when data is incomplete.
  • Works with internal staff members, provider office staff, academic entities and/or other health related entities to verify the accuracy of the information provided.
  • Generates reports from system for prioritization of work queue.
  • Evaluates and researches practitioners that do not meet network participation criteria or are found to have on-going sanction monitoring issues.
  • Gathers and summarizes information for Credentialing Committee or Provider Contracting and responds to questions as needed.
  • Researches questions for accreditation or regulatory audits.
  • Supports special projects as needed.
  • Performs other duties as assigned.
  • Associate degree in business or healthcare administration or related field, or equivalent combination of education/training and experience.
  • 1 year of experience as a Provider Credentialing & Data Specialist or equivalent experience in a health plan, medical office, hospital, or similar administration.
  • Intermediate Microsoft Office (Word, Excel), database reporting, OnBase (document management system), and internet navigation skills.
  • Knowledge of provider credentialing and/or database management procedures.
  • Strong data entry skills.
  • CPCS certification preferred but not required.
  • Employee bonus program.
  • 401(k) with company match up to 4% and an additional company contribution.
  • Health Savings Account with a company matching contribution.
  • Excellent medical, dental, vision, life and disability insurance.
  • Access to an Employee Assistance Program, which includes professional counseling, personal and professional coaching, self-help resources and assistance with work/life benefits.
  • Company holidays and up to 16 PTO days during the first year of employment with options to carry over unused PTO time.
  • Parental leave for eligible employees who become parents through maternity, paternity or adoption after 120 days of service.
  • Career development programs and classes.
  • Mentoring and coaching to help you advance in your career.
  • Tuition reimbursement up to $5,250 per year.
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