Provider Network Data Maintenance Associate

PacificSource•Boise, ID

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 accurate and current for effective operations and timely reimbursements. The position also supports provider directory maintenance, data audits, issue resolution, quality assurance, and process improvement. It may involve communicating with providers to obtain documentation or clarify discrepancies, and participating in projects related to network expansion, system upgrades, or regulatory changes.

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 skills, 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 in PacificSource systems.
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, compliance with internal standards, and regulatory requirements.
Assist in managing provider directories so they remain 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 teams to resolve provider data issues.
Research and respond to detailed provider inquiries routed from customer and provider service departments.
Communicate with providers to obtain documentation or clarify data discrepancies.
Support team members and maintain effective working relationships across teams and departments.
Identify process improvements and contribute to quality assurance initiatives for provider data accuracy and efficiency.
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.
Meet department and company performance and attendance expectations while maintaining data accuracy and productivity.
Follow PacificSource privacy policy and HIPAA requirements for confidentiality and security of protected health information.
Perform other duties as assigned.