Provider Network Data Maintenance Associate

PacificSource•Portland, OR

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 manages 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 keep provider information current and support smooth operations and timely reimbursements. The position also supports provider directory maintenance, data audits, provider inquiries, process improvements, quality assurance, and projects involving network expansion, system upgrades, or regulatory changes. The Associate follows privacy and HIPAA requirements, meets performance and attendance expectations, and contributes to the overall effectiveness of Provider Network Operations.

Requirements

At least 2 years of experience in an office environment.
High school diploma or equivalent.
Fast and accurate data entry skills.
Self-motivation and ability to learn and be trained on new systems, databases, and applications.
Effective written and oral communication skills.
Proficient computer skills, typing, and 10-key skills.
Ability to read and comprehend written and spoken English and communicate clearly and effectively.
Ability to meet the position’s physical requirements, including sitting and/or standing for extended periods, repetitive typing, sorting and filing, stooping and bending, and light lifting and carrying.

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

Accurately and promptly enter and update demographic, credentialing, and contract information for new and re-credentialed network providers.
Process provider additions, terminations, and changes in a timely manner, maintaining data integrity and accurate contract rows for claims payments.
Audit provider data for accuracy and compliance with internal standards and regulatory requirements.
Assist with managing provider directories so they are 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 inquiries routed from customer and provider service departments.
Contact providers to obtain documentation or clarify data discrepancies.
Provide support to team members as needed.
Identify process improvement opportunities and contribute to quality assurance initiatives.
Assist with 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 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 policies and HIPAA laws and regulations regarding confidentiality and security of protected health information.
Perform other duties as assigned.