Provider Network Data Maintenance Associate
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, ensures compliance with regulatory requirements, and supports Provider Network Operations with 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 information accurate and support smooth operations and timely reimbursements. The position also supports provider directories, compliance monitoring, issue resolution, process improvements, quality assurance, and projects involving network expansion, system upgrades, or regulatory changes. It requires maintaining effective working relationships, following privacy and HIPAA requirements, and meeting performance, attendance, accuracy, and productivity expectations. The work is performed inside in a general office setting with ergonomically configured equipment; travel may be 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, 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 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, regulatory requirements, and data maintenance practices.
- Assist with 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 internal teams to resolve provider data issues.
- Research and respond to detailed provider inquiry issues 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 improvements in provider data management 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.
- Meet department and company performance and attendance expectations, 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.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
