Provider Data Specialist I
---------------------------------------------------------------
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. Correctly configure provider data and contract information using written guidelines. 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:
$23.28 - $28.45
Bonus Target:
Bonus - SIP Target, 5% Annual
Priority will be given to candidates residing in Oregon and Southwest Washington.
Current CareOregon Employees: Please use the internal Workday site to submit an application for this job.
---------------------------------------------------------------
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.
- 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.
- Data validation through license boards, IRS, NPPES, and other t