Provider Database Coordinator

Centene Corporation

1d•Remote

About The Position

Under supervision, the Provider Database Coordinator ensures the accuracy and completeness of provider data as reflected in Health Net’s databases, systems and provider directory. This position works collaboratively with providers, Network Management and Provider Data Services staff to ensure Health Net provider data is current and accurate. Duties include identifying, researching and resolving inconsistent data. Responsible for the accuracy and timeliness of Health Net provider data. Enters provider data according to established department standards. Reconciles data from various data file types to ensure quality results for internal and external customer bases. Works with provider offices to assure accuracy of provider data. Responds to inquiries and issues related to provider data coming directly from providers and other Network Management staff. If necessary, appropriately and timely refer issues to Network Management staff. Works with providers and Provider Relations staff to capture and process provider demographic changes. This includes changes received via mail, fax, electronic or from other sources. May prepare Inquiry Service Form (ISF) for demographic changes and submits to Provider Data Services for loading in accordance with standard turnaround times. Communicates appropriate information/changes to providers to allow to enable timely and accurate claim payment. Conducts ongoing monitoring of provider database including data on facilities and physicians. Ensures provider directories are current and accurate. Facilitates or assists with special projects and other initiatives to ensure provider data is complete and accurate. May participate in training and educational activities for providers and internal customers.

Requirements

High School diploma required
Three years general data management experience in an automated claims processing, claims research, or provider maintenance environment.
Two years experience in provider relations, provider contracting; health plan operations or health care/medical office environment.

Nice To Haves

Some college level coursework desirable

Responsibilities

Ensures the accuracy and completeness of provider data as reflected in Health Net’s databases, systems and provider directory.
Works collaboratively with providers, Network Management and Provider Data Services staff to ensure Health Net provider data is current and accurate.
Identifies, researches and resolves inconsistent data.
Responsible for the accuracy and timeliness of Health Net provider data.
Enters provider data according to established department standards.
Reconciles data from various data file types to ensure quality results for internal and external customer bases.
Works with provider offices to assure accuracy of provider data.
Responds to inquiries and issues related to provider data coming directly from providers and other Network Management staff.
Appropriately and timely refers issues to Network Management staff if necessary.
Works with providers and Provider Relations staff to capture and process provider demographic changes.
Prepares Inquiry Service Form (ISF) for demographic changes and submits to Provider Data Services for loading in accordance with standard turnaround times.
Communicates appropriate information/changes to providers to allow for timely and accurate claim payment.
Conducts ongoing monitoring of provider database including data on facilities and physicians.
Ensures provider directories are current and accurate.
Facilitates or assists with special projects and other initiatives to ensure provider data is complete and accurate.
May participate in training and educational activities for providers and internal customers.