Provider Network Data Maintenance Associate

PacificSource Health Plans•WFH: MO, MO

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 regulatory compliance, and manages information 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 accurate, supporting smooth operations and timely reimbursements. The position also supports provider directory maintenance, data audits, provider inquiries, quality assurance, and process improvement. It may involve communicating with providers to obtain documentation or resolve discrepancies, and participating in projects related to network expansion, system upgrades, or regulatory changes. The work is performed inside in a general office setting with ergonomically configured equipment. Travel may be required 5% of the time for training and/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.
Ability to meet the physical requirements of the role, including stooping and bending, sitting and/or standing for extended periods, repetitive typing, sorting and filing, and light lifting and carrying of files and business materials.

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 promptly and accurately in PacificSource systems 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 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 for compliance 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 discrepancies in data.
Support team members and contribute to the overall effectiveness of provider network operations.
Identify process improvements in 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 requirements for confidentiality and security of protected health information.
Perform other duties as assigned.