Provider Data Management Specialist

CommonSpirit Health•Bakersfield, CA

2d•Remote

About The Position

The Clinical Integration (CI) and Accountable Care Organization (ACO) programs are clinically integrated physician networks sponsored by Dignity Health (DH). In order to fill service gaps in a CI/ACO Network, a complementary network of ancillary providers is maintained in each region. The Provider Data Management Specialist is an employee of Dignity Health Management Service. Under the direction of the Manager, this individual: - provides data management support services to Dignity Health’s CI/ACO Networks, Employer Relations and Valued Based Operations (VBO) - within the Salesforce platform, this individual gathers and maintains accurate provider data, performs periodic provider data reconciliations with multiple data sources, including 3rd party payors - generates reporting on the provider network - conducts review of network adequacy and capabilities - maintains and transmits fee schedules, as necessary, to third-party administrators (TPA's) and other appropriate stakeholders - provides customer support services to Dignity Health CI/ACO Networks and VBO’s team. The Provider Data Management Specialist also supports network development to ensure the integrity, accuracy, and completeness of provider information across internal systems, enabling efficient operations, compliance, and network performance. This role is foundational to the success of network optimization efforts in each of the national Value-Hub markets. This position is remote, but will be expected to work PST business hours.

Requirements

Minimum 3 years’ experience in provider relations, provider credentialing, provider database maintenance and reporting, provider contracting and/or network development in a health care or managed care setting
HS diploma or GED
Demonstrated skills in the areas of written and verbal communication, judgment, and problem-solving.
Strong proficiency in Microsoft Office products required.
This position requires a highly motivated person with exceptional customer service, relationship management and interpersonal skills.
Attention to detail.
Capable of independent thinking, as well as perform in a team environment.

Nice To Haves

Bachelors degree in Business, Finance, Health Care Management, Economics preferred

Responsibilities

provides data management support services to Dignity Health’s CI/ACO Networks, Employer Relations and Valued Based Operations (VBO)
within the Salesforce platform, this individual gathers and maintains accurate provider data, performs periodic provider data reconciliations with multiple data sources, including 3rd party payors
generates reporting on the provider network
conducts review of network adequacy and capabilities
maintains and transmits fee schedules, as necessary, to third-party administrators (TPA's) and other appropriate stakeholders
provides customer support services to Dignity Health CI/ACO Networks and VBO’s team
supports network development to ensure the integrity, accuracy, and completeness of provider information across internal systems, enabling efficient operations, compliance, and network performance