Provider Database Coordinator - JHP

Jefferson Health Plans • Philadelphia, PA

2d • Onsite

About The Position

Working under the direct supervision of the Supervisor, Provider Database Maintenance, perform provider database maintenance duties to ensure the managed health care system reflects accurate and updated provider demographic information for all participating and non-participating providers. This includes, but is not limited to: Physicians and other Individual Providers, Ancillaries, Facilities, Hospital-based, and Facility-based.

Requirements

• High School Diploma/GED
• Database, organizational, written and verbal communication skills, and ability to work independently or as part of a team.
• Strong relational database experience, health insurance industry preferred.
• Proficient in Microsoft Outlook and working knowledge of Microsoft Excel or Access, and MS Word.

Responsibilities

• Able to work in a constant state of alertness and safe manner.
• Maintain and foster a collaborative relationship with internal and external customers.
• Precisely complete all Claims and Reconsideration Service Forms according to department’s service-level agreement with Claims.
• Precisely complete Credentialing, PDC, and Finance service forms according to expected levels of quality and timeliness.
• Enter demographic data of new providers into provider network database and assign fee schedule and related pricing/contract information.
• Make necessary changes to demographic and pricing/contract data for existing providers.
• Retrieve, validate and perform any necessary updates based on production reports for all providers. Reports include, but are not limited to: Credentialing to Claims system mismatch, Members attached to terminated PCPs, Active providers with sanctions, Encounter errors.
• Identify and report possible problems with the provider network database files.
• Participate in ongoing projects, as necessary, and in staff and/or committee meetings and training.
• File provider information and documentation in designated areas and with Document Control, if necessary.
• Utilize credentialing system inquiry functions to help maintain correct data for participating providers in the provider network database.
• Perform other job duties as required by Network Management.

Benefits

• Medical (including prescription)
• Supplemental insurance
• Dental
• Vision
• Life and AD&D insurance
• Short- and long-term disability
• Flexible spending accounts
• Retirement plans
• Tuition assistance
• Voluntary benefits
• Tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED