Provider Data Maintenance Specialist

DRISCOLL HEALTH PLAN•Corpus Christi, TX

8d•Onsite

About The Position

Where compassion meets innovation and technology and our employees are family. Thank you for your interest in joining our team! Please review the job information below. This position is 100% onsite. General Purpose of Job: The Provider Data Maintenance Specialist is responsible for researching and gathering data and converting it into meaningful information/reports/files used by the Driscoll Health Plan in the Provider Contracting, Credentialing and Claims systems. Essential Duties and Responsibilities: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This job description is not intended to be all-inclusive; employees will perform other reasonably related business duties as assigned by the immediate supervisor and/or health plan administration as required. Maintains utmost level of confidentiality at all times. Adheres to DHS/DHP policies and procedures. Demonstrates business practices and personal actions that are ethical and adhere to corporate compliance and integrity guidelines. Ensures the integrity of provider data, including research, data extraction, processing, storage, manipulation, analysis and distribution of Provider Data from Credentialing, Contracting and State and Federal databases. Creates Add Files and Change Files ensuring data integrity of all provider data being loaded into DHP contracting, credentialing, claims and authorization systems. Provides resolution of all DHP Claims Provider Not Found Queue’s to load required Provider data for adjudication on a Participating or Non-participating basis expeditiously as required to meet state mandated claims turnaround time frames. Is a Subject Matter Expert on the State of Texas Master Provider File (MPF) and the NPPES NPI Registry in regards to Provider Data required to load Provider information Utilizes DHP CRM to communicate with DHP Departments to provide required provider data to the appropriate department for system load. Is a Subject Matter expert on DHP Credentialing and Contracting system’s Provider Data. Performs other related work as required. Education and/or Experience: Any combination of education and experience that would likely provide the required knowledge, skills, and abilities is qualifying. Degree Preferred. Typically has 6+ years' experience in Texas Medicaid MCO Provider Data Management. Knows fundamental concepts, practices and procedures of particular field of specialization. Until all children are well. Driscoll Children’s Hospital and its specialty centers, urgent care centers, and after-hours facility serve a vast area covering 31 South Texas counties. The hospital is a 191-bed tertiary care center offering 32 medical and 13 surgical specialties. Combined with our non-profit, community-based Health Plan, Driscoll Health System is an exceptional workplace for anyone with a big heart and a drive for success. Smiles, hugs and a soothing touch are as much a part of Driscoll’s approach to treating children as is its advanced medical treatments and technologies. The core values at Driscoll Heath System are: Compassion, Advocacy, Respect, Excellence, and Stewardship. These values are exemplified through every position - from treating the most critical patients hands-on, to maintaining a clean environment, to keeping the organization running from behind the scenes. We invite you to learn about Driscoll’s rich history and explore the laidback lifestyle South Texas has to offer.

Requirements

Any combination of education and experience that would likely provide the required knowledge, skills, and abilities is qualifying.
Typically has 6+ years' experience in Texas Medicaid MCO Provider Data Management.
Knows fundamental concepts, practices and procedures of particular field of specialization.

Nice To Haves

Degree Preferred.

Responsibilities

Maintains utmost level of confidentiality at all times.
Adheres to DHS/DHP policies and procedures.
Demonstrates business practices and personal actions that are ethical and adhere to corporate compliance and integrity guidelines.
Ensures the integrity of provider data, including research, data extraction, processing, storage, manipulation, analysis and distribution of Provider Data from Credentialing, Contracting and State and Federal databases.
Creates Add Files and Change Files ensuring data integrity of all provider data being loaded into DHP contracting, credentialing, claims and authorization systems.
Provides resolution of all DHP Claims Provider Not Found Queue’s to load required Provider data for adjudication on a Participating or Non-participating basis expeditiously as required to meet state mandated claims turnaround time frames.
Is a Subject Matter Expert on the State of Texas Master Provider File (MPF) and the NPPES NPI Registry in regards to Provider Data required to load Provider information
Utilizes DHP CRM to communicate with DHP Departments to provide required provider data to the appropriate department for system load.
Is a Subject Matter expert on DHP Credentialing and Contracting system’s Provider Data.
Performs other related work as required.