Provider Data Specialist
About The Position
Our Client, a Health Insurance company, is looking for a Provider Data Specialist for their Detroit, MI/Hybrid location. The original scope for bringing a specialist onboard is to work on PIAI projects provider data clean up measures. Upon completion of projects, we are finding that these projects are turning into ongoing processes. For example: State of Michigan BH (SOM BH) Audit provider outreach, Provider Data Confidence Value (PDCV) audit provider outreach, return mail, facility attestation noncompliant providers, daily CAQH Directory Verification task. Validating provider information through auditing processes to reduce and eliminate inaccurate data for accuracy and auditing purposes. Increase provider accuracy on members website by eliminating outdated information. Perform several outreaches daily to providers across Michigan to verify certainty of demographic information such as phone numbers, address, accepting new patients. Review and process results of audits for validity in collaboration with leadership to ensure accurate data is uploaded into database.
Requirements
- Proficiency in Excel
- Proficiency in Access
- Proficiency in Outlook
- Proficiency in PORTICO
- Proficiency in SF MACESS
- Proficiency in FACETS
- High school diploma
- 3 to 5 years experience
Responsibilities
- Work on PIAI projects provider data clean up measures.
- Perform State of Michigan BH (SOM BH) Audit provider outreach.
- Perform Provider Data Confidence Value (PDCV) audit provider outreach.
- Handle return mail.
- Address facility attestation noncompliant providers.
- Perform daily CAQH Directory Verification tasks.
- Validate provider information through auditing processes to reduce and eliminate inaccurate data for accuracy and auditing purposes.
- Increase provider accuracy on members website by eliminating outdated information.
- Perform several outreaches daily to providers across Michigan to verify certainty of demographic information such as phone numbers, address, accepting new patients.
- Review and process results of audits for validity in collaboration with leadership to ensure accurate data is uploaded into database.
Benefits
- Health Benefits
- Referral Program
- Excellent growth and advancement opportunities
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
