Provider Network Data Maintenance Associate

PacificSource•Springfield, OR

1d•$35,543 - $56,869

About The Position

The Provider Network Data Maintenance Associate maintains the accuracy and integrity of provider data in PacificSource systems. The role updates provider records, supports compliance with regulatory requirements, and assists Provider Network Operations with data related to provider contracts, reimbursements, and credentialing. The Associate works with Provider Relations, Provider Reimbursement Analytics, Provider Network Credentialing and Compliance, and other teams to ensure provider information is accurate and current for smooth operations and timely claims payments. The role also supports provider directory maintenance, provider inquiries, quality assurance, process improvements, and projects involving network expansion, system upgrades, or regulatory changes. Work takes place in a general office setting with ergonomically configured equipment. Travel may be required up to 5% of the time for training or external meetings.

Requirements

At least 2 years of experience in an office environment.
High school diploma or equivalent.
Fast and accurate data-entry skills.
Ability to learn and be trained on new systems, databases, and applications.
Effective written and oral communication skills.
Proficient computer, typing, and 10-key skills.
Ability to read and comprehend written and spoken English and communicate clearly and effectively.

Nice To Haves

Experience in healthcare data management, network operations, or data analysis.
Familiarity with provider network operations, including provider credentialing, healthcare regulatory requirements, contracting, or reimbursement processes.
Associate’s or bachelor’s degree.
Knowledge of medical terminology and CPT/ICD-10 coding.

Responsibilities

Enter and update provider demographic, credentialing, and contract information accurately and promptly for new and re-credentialed network providers, meeting department service-level expectations.
Process provider additions, terminations, and changes in a timely manner, maintaining data integrity and accurate contract rows for claims payments.
Audit provider data regularly for accuracy, compliance with internal standards, and compliance with regulatory requirements.
Assist with managing provider directories to keep them current, accurate, and useful to members.
Verify provider licensure and Medicare and Medicaid eligibility using compliance-approved tools.
Monitor and maintain provider records in accordance with organizational policies, procedures, and contracting regulations.
Collaborate with Provider Relations, Credentialing, Contracting, and other internal teams to resolve provider data issues.
Research and respond to detailed provider inquiry issues routed from customer and provider service departments.
Contact providers to obtain documentation or clarify data discrepancies.
Support other team members as needed to help ensure effective provider network operations.
Identify process improvements for provider data management and maintenance, and contribute to quality assurance initiatives.
Assist in developing and implementing best practices for provider data entry and maintenance.
Participate in projects related to provider network expansion, system upgrades, or regulatory changes.
Maintain positive and effective working relationships with team members and other departments.
Meet department and company performance and attendance expectations while maintaining data accuracy and productivity.
Follow PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
Perform other duties as assigned.