Provider Data Specialist I
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This position is responsible for providing product support to provider data within the QNXT module. Primary tasks include adding, maintaining, and updating provider data records, as well as assistance with database integrity. Accurate and timely provider data plays a critical role in the success of claims payment, OHA Health Systems (DMAP) and CMS encounter data submission, PCP assignment, authorization processing, credentialing, IRS reporting, regulatory projects, and the provider directory.
Estimated Hiring Range:
$22.82 - $27.89
Bonus Target:
Bonus - SIP Target, 5% Annual
Current CareOregon Employees: Please use the internal Workday site to submit an application for this job.
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Essential Responsibilities
Provider Database Maintenance
- Perform accurate and timely data entry into provider database, following Provider Data policies and procedures.
- Provide data management and process knowledge to the organization; assist with projects.
- Investigate and resolve provider and provider contract pending claims as requested by more advanced Provider Data staff; apply claims policies and procedures.
- Monitor call and email queues by reviewing requests and communicating clearly and timely with contracted provider offices and internal customers; research demographic and affiliations changes; make updates to provider database reflecting new information once validated.
- Manage monthly provider rosters received from contracted hospital systems and IPAs by investigating changes and validating information prior to updating QNXT; consult with advanced Provider Data staff to clarify information.
- Complete provider database projects resulting from contracting, configuration, or regulatory changes.
- Sort incoming faxes, PIVs and distribute according to assignments.
- Maintain SharePoint libraries according to unit protocols.
- Enroll providers with OHA Health Systems using MMIS web enrollment portal.
- Reroute critical pieces of return mail including 1099s, live checks and remittance advice by investigating demographic discrepancies and reflecting changes in QNXT.
- Create and maintain security access for provider web portal; troubleshoot and investigate provider portal issues when they arise.
Provider Database Integrity
- Troubleshoot provider setup to support provider reporting, directory, and claims operation.
- Perform testing of new software versions.
Experience and/or Education
Required
- Minimum 1 years’ experience with data entry, data management, or credentialing
Preferred
- 2 years' experience working in health care/insurance
- Experience with managed care and/or project participation
Knowledge, Skills and Abilities Required
Knowledge
- Familiarity with relational databases
- General understanding of or ability to learn managed care and Oregon Health Plan concepts
- Familiarity with Microsoft Office Suite products, especially Excel
Skills and Abilities
- Ability to learn and effectively navigate claims processing technologies, such as QNXT and Facets
- Ability to learn and effectively navigate document management and collaboration platforms, such as SharePoint and Office 365
- Ability to follow policies and procedures in performing job responsibilities
- Ability to develop skills around troubleshooting data integrity issues and root cause
- Ability to learn how to author and maintain process documentation
- Proficient communication skills, including listening, verbal, written, and customer service
- Ability to articulate instructions
- Learning to convey appropriate level of detail effectively to multiple levels of the organization including non-technical staff
- Ability to learn to appropriately communicate status and needs
- General ability to learn to handle multiple priorities and requests
- Demonstrates general initiative and motivation
- Ability to effectively collaborate with coworkers
- Attention to details and deadlines
- Ability to learn to see the big picture
- Developing organizational skills
- Ability to prioritize work based on direction
- Ability to develop analytical and research skills
- Ability to maintain a positive attitude
- Ability to learn governance and process
- Ability to work effectively with diverse individuals and groups
- Ability to learn, focus, understand, and evaluate information and determine appropriate actions
- Ability to accept direction and feedback, as well as tolerate and manage stress
- Ability to see, read, and perform repetitive finger and wrist movement for at least 6 hours/day
- Ability to hear and speak clearly for at least 3-6 hours/day
Working Conditions
Work Environment(s): ☒ Indoor/Office ☐ Community ☐ Facilities/Security ☐ Outdoor Exposure
Member/Patient Facing: ☒ No ☐ Telephonic ☐ In Person
Hazards: May include, but not limited to, physical and ergonomic hazards.
Equipment: General office equipment
Travel: May include occasional required or optional travel outside of the workplace; the employee’s personal vehicle, local transit or other means of transportation may be used.
Work Location: Work from home
Schedule: Monday - Friday, 8:00 AM to 5:00 PM
We offer a strong Total Rewards Program. This includes competitive pay, bonus opportunity, and a comprehensive benefits package. Eligibility for bonuses and benefits is dependent on factors such as the position type and the number of scheduled weekly hours. Benefits-eligible employees qualify for benefits beginning on the first of the month on or after their start date. CareOregon offers medical, dental, vision, life, AD&D, and disability insurance, as well as health savings account, flexible spending account(s), lifestyle spending account, employee assistance program, wellness program, discounts, and multiple supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, 529 College Savings, etc.). We also offer a strong retirement plan with employer contributions. Benefits-eligible employees accrue PTO and Paid State Sick Time based on hours worked/scheduled hours and the primary work state. Employees may also receive paid holidays, volunteer time, jury duty, bereavement leave, and more, depending on eligibility. Non-benefits eligible employees can enjoy 401(k) contributions, Paid State Sick Time, wellness and employee assistance program benefits, and other perks. Please contact your recruiter for more information.
We are an equal opportunity employer
CareOregon is an equal opportunity employer. The organization selects the best individual for the job based upon job related qualifications, regardless of race, color, religion, sexual orientation, national origin, gender, gender identity, gender expression, genetic information, age, veteran status, ancestry, marital status or disability. The organization will make a reasonable accommodation to known physical or mental limitations of a qualified applicant or employee with a disability unless the accommodation will impose an undue hardship on the operation of our organization.