Provider Data Specialist

CHPW•Seattle, WA

7d•Onsite

About The Position

This position is responsible for interpreting, analyzing, researching and maintaining accuracy of provider file data across multiple databases, including the accuracy of the provider directory. To be successful in this role, you: Have one (1) year experience in a healthcare/insurance setting, Managed Care or Commercial health insurance, Provider Data Services, Provider Network Administration. Have a minimum of one (1) year’s work experience with Provider Relations, Customer Service, Claims or Provider Data Analysis preferred. Have data entry, data interpretation, and analytical problem-solving abilities. Have experience with Microsoft Office applications such as Excel, Word, and Outlook. Essential functions and Roles and Responsibilities: Act as the technical provider data expert, following state and federal guidelines, and Community Health Plan of Washington (CHPW) provider contracts. Prepare, categorize, and reconcile source documents. Identify and interpret data to be updated in claims and credentialing systems, and online provider directory. Accurately add and update provider data in appropriate database(s). Prepare Provider Add Change Term (PACT) forms to submit for provider and vendor record changes in the claims payment system. Resolve issues with PACT forms. Serve as a technical provider data contact for providers, acting as a liaison regarding provider data updates, issues, claims questions. Research, resolve and respond to claims processing and provider reimbursement issues related to contract payment and accurate configuration of provider data in the claims system. Provide feedback to the Configuration team to ensure provider contracts are configured in the system correctly. Initiate team projects that enhance quality assurance, streamline workflow, and identify process improvements. Other duties as assigned. Essential functions listed are not necessarily exhaustive and may be revised by the employer, at its sole discretion.

Requirements

Have one (1) year experience in a healthcare/insurance setting, Managed Care or Commercial health insurance, Provider Data Services, Provider Network Administration.
Have data entry, data interpretation, and analytical problem-solving abilities.
Have experience with Microsoft Office applications such as Excel, Word, and Outlook.
Complete and successfully pass a criminal background check
Has not been sanctioned or excluded from participation in federal or state healthcare programs by a federal or state law enforcement, regulatory, or licensing agency
Vaccination requirement (CHPW offers a process for medical or religious exemptions)

Nice To Haves

Have a minimum of one (1) year’s work experience with Provider Relations, Customer Service, Claims or Provider Data Analysis preferred.

Responsibilities

Act as the technical provider data expert, following state and federal guidelines, and Community Health Plan of Washington (CHPW) provider contracts.
Prepare, categorize, and reconcile source documents.
Identify and interpret data to be updated in claims and credentialing systems, and online provider directory.
Accurately add and update provider data in appropriate database(s).
Prepare Provider Add Change Term (PACT) forms to submit for provider and vendor record changes in the claims payment system.
Resolve issues with PACT forms.
Serve as a technical provider data contact for providers, acting as a liaison regarding provider data updates, issues, claims questions.
Research, resolve and respond to claims processing and provider reimbursement issues related to contract payment and accurate configuration of provider data in the claims system.
Provide feedback to the Configuration team to ensure provider contracts are configured in the system correctly.
Initiate team projects that enhance quality assurance, streamline workflow, and identify process improvements.
Other duties as assigned.