Provider Network Data Maintenance Associate

PacificSource Health Plans•Portland, OR

1d•$35,543 - $56,869

About The Position

The Provider Network Data Maintenance Associate maintains accurate and complete provider data in organizational systems. The role updates provider records, supports regulatory compliance, and manages information related to provider contracts, reimbursements, credentialing, and directories. 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 claims payments. The position also helps resolve provider data issues and inquiries, communicates with providers to obtain documents or clarify discrepancies, supports quality assurance and process improvements, and contributes to projects involving network expansion, system upgrades, and regulatory changes. 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.
Proficient computer, typing, and 10-key skills.
Effective written and oral communication skills.
Ability to learn and be trained on new systems, databases, and applications.
Self-motivation.
Ability to read and comprehend written and spoken English and communicate clearly and effectively.
Ability to meet department and company performance and attendance expectations.

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 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 for accuracy, compliance with internal standards and regulatory requirements, and ongoing data integrity.
Help manage provider directories so they are current, accurate, and meet members’ needs.
Verify provider licensure and Medicare and Medicaid eligibility using compliance-approved tools, meeting 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 internal 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 and clarify data discrepancies.
Support other team members and contribute to the effectiveness of provider network operations.
Identify process-improvement opportunities 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 high data accuracy and productivity.
Follow PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
Perform other duties as assigned.