Provider Data Specialist I
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Job Description
Provider Data Specialist maintaining CareOregon’s health-plan provider records, contracts, and directories. Supporting QNXT data integrity, claims processing, regulatory reporting, and provider operations.
Responsibilities:
- Provide product support for provider data within the QNXT module
- Add, maintain, and update provider data records
- Assist with database integrity
- Configure provider data and contract information using written guidelines
- Perform accurate and timely data entry following Provider Data policies and procedures
- Provide data management and process knowledge; assist with projects
- Investigate and resolve provider and provider contract pending claims
- Monitor call and email queues and communicate with contracted provider offices and internal customers
- Research demographic and affiliation changes and update the provider database after validation
- Manage monthly provider rosters from contracted hospital systems and IPAs
- Complete provider database projects resulting from contracting, configuration, or regulatory changes
- Sort incoming faxes and PIVs and distribute them according to assignments
- Maintain SharePoint libraries
- Enroll providers with OHA Health Systems using the MMIS web enrollment portal
- Reroute critical returned mail, including 1099s, live checks, and remittance advice
- Troubleshoot provider portal issues
- Troubleshoot provider setup supporting reporting, directories, and claims operations
- Test new software versions
- Validate data through license boards, IRS, NPPES, and other third-party sources
- Resolve data errors through troubleshooter processes and internal audits
Requirements:
- Minimum 1 year of experience with data configuration, data management, credentialing, or claims management
- 2 years of experience working in health care/insurance preferred
- Experience with managed care and/or project participation preferred
- 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
- 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
- Ability to develop troubleshooting data integrity and root-cause skills
- Ability to author and maintain process documentation
- Proficient listening, verbal, written, and customer service communication skills
- Ability to articulate instructions and communicate effectively with multiple organizational levels, including non-technical staff
- Ability to handle multiple priorities and requests
- Attention to detail and deadlines
- Ability to develop analytical and research skills
- Ability to work effectively with diverse individuals and groups
- 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
Benefits:
- Bonus - SIP Target, 5% Annual
- Medical, dental, vision, life, AD&D, and disability insurance
- Health savings account
- Flexible spending account(s)
- Lifestyle spending account
- Employee assistance program
- Wellness program
- Discounts
- Supplemental benefits including voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, and 529 College Savings
- Retirement plan with employer contributions
- PTO
- Paid State Sick Time
- Paid holidays
- Volunteer time
- Jury duty leave
- Bereavement leave
- 401(k) contributions for non-benefits-eligible employees
- Work from home
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