Provider Network Data Maintenance Associate

PacificSource•Springfield, OR

5d•Onsite

About The Position

The Provider Network Data Maintenance Associate maintains accurate and complete provider data in organizational systems. The role updates provider demographic, credentialing, and contract information; 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, verifies provider licensure and Medicare and Medicaid eligibility using approved tools, researches provider data issues, and communicates with providers to obtain documentation or resolve discrepancies. It contributes to audits, quality assurance, process improvements, best-practice development, and projects involving network expansion, system upgrades, or regulatory changes. The role works in a general office setting with ergonomically configured equipment, with travel potentially required 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 skills, typing, and 10-key skills.
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 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.
Travel availability for training and/or external meetings, which may be required 5% of the time.

Responsibilities

Enter and update demographic, credentialing, and contract information for new and re-credentialed network providers accurately and promptly, 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, and ongoing data integrity.
Help manage provider directories so they remain current, accurate, and useful to members.
Verify provider licensure and Medicare and Medicaid eligibility using compliance-approved tools and ensure data meets 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 provider inquiries routed from customer and provider service departments.
Communicate with providers to obtain documentation or clarify data discrepancies.
Support other team members and maintain effective working relationships across teams and departments.
Identify process improvement opportunities and contribute to quality assurance initiatives to improve data accuracy and efficiency.
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.
Meet department and company performance and attendance expectations while maintaining data accuracy and productivity.
Follow PacificSource privacy policies and HIPAA requirements for confidentiality and security of protected health information.
Perform other duties as assigned.