Provider Network Data Maintenance Associate
About The Position
The Provider Network Data Maintenance Associate maintains accurate and complete provider data in PacificSource systems. The role updates provider records, supports compliance with regulatory requirements, and manages information related to provider contracts, reimbursements, and credentialing in support of Provider Network Operations. 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, provider inquiries, data audits, quality assurance, process improvements, and projects involving provider network expansion, system upgrades, or regulatory changes. The work is performed indoors 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 meet department and company performance and attendance expectations.
- Ability to follow privacy and HIPAA requirements.
- Ability to read and comprehend written and spoken English and communicate clearly and effectively.
- Ability to stoop and bend, sit and/or stand for extended periods, perform repetitive typing, sorting, and filing, and lightly lift and carry 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.
- Self-motivation.
Responsibilities
- Enter and update provider demographic, credentialing, and contract information in PacificSource systems accurately and promptly, meeting department service-level expectations.
- Process provider additions, terminations, and changes in a timely manner to maintain data integrity and ensure correct contract rows for claims payments.
- Audit provider data to verify accuracy, compliance with internal standards and regulatory requirements, and ongoing data integrity.
- Assist with managing provider directories so they are current, accurate, and meet members’ needs.
- Verify provider licensure and Medicare and Medicaid eligibility using compliance-approved tools, ensuring data meets state and federal regulatory and accreditation standards.
- 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 inquiries routed from customer and provider service departments.
- Communicate with providers to obtain documentation or clarify data discrepancies.
- Support other team members as needed to promote effective provider network operations.
- Identify process improvement opportunities in provider data management and maintenance, and contribute to quality assurance initiatives.
- Assist with developing and implementing provider data entry and maintenance best practices, and participate in projects involving 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 high data accuracy and productivity.
- Follow PacificSource privacy policy and HIPAA requirements for confidentiality and security of protected health information.
- Perform other duties as assigned.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
