Provider Data Maintenance Spec

Health Care Service Corporation•El Paso, TX

21h•$19 - $34

About The Position

At CareAllies, employees are described as the cornerstone of the business and its success. The company supports employee growth through curated development plans. This position analyzes and researches requests from providers and applies business rules to add, delete, or change provider information used for claims processing, membership assignment, and directory purposes. The role reviews contracting, credentialing, and maintenance of provider data to support claims payment, Marketing, Membership, and Network Contracting across all lines of business. It administers provider contracts, rosters, and requests accurately and promptly, supporting quality initiatives and data accuracy. The position participates in internal provider meetings and work groups and researches issues involving provider credentialing, data, and network participation. It serves as a liaison among Network Contracting, Enterprise Credentialing, Product Development, Special Investigations, Legal, Marketing, Full Service Units, ITG, Government Programs, and other business partners on network activities. The posting says the ideal candidate must reside within a reasonable commuting distance of the El Paso, Texas local office. It also states that the position may be performed remotely from anywhere in the continental United States, excluding California, New York, Alaska, and Hawaii.

Requirements

Two years of college and/or two years of relevant experience.
Written and verbal communication skills to interact with internal and external customers.
Analytical and quantitative skills.
Ability to take initiative and work independently.

Nice To Haves

Working knowledge of the professional provider credentialing process.
One year of experience in Provider Data.
Experience with Microsoft Office applications, including Excel, Access, and PowerPoint.
Bilingual Spanish skills are highly preferred but not required.
Experience using Salesforce is a plus.

Responsibilities

Analyze and research provider requests and apply business rules to add, delete, or change provider information used for claims processing, membership assignment, and directory purposes.
Review provider contracting, credentialing, and data maintenance to support claims payment, Marketing, Membership, and Network Contracting across all lines of business.
Administer provider contracts, rosters, and requests accurately and timely, supporting quality initiatives and data accuracy.
Participate in internal provider meetings and work groups.
Research problems related to provider credentialing, data, and network participation.
Act as a liaison among Network Contracting, Enterprise Credentialing, Product Development, Special Investigations, Legal, Marketing, Full Service Units, ITG, Government Programs, and other business partners on network activities.