Provider Database Coordinator

Number of Positions In Requisition

1

Working under the direct supervision of the Supervisor, Provider Database Maintenance, perform provider database maintenance duties to ensure the managed health care system reflects accurate and updated provider demographic information for all participating and non-participating providers. This includes, but is not limited to:

• Physicians and other Individual Providers
• Ancillaries
• Facilities
• Hospital-based
• Facility-based

Summary Working under the direct supervision of the Supervisor, Provider Database Maintenance, perform provider database maintenance duties to ensure the managed health care system reflects accurate and updated provider demographic information for all participating and non-participating providers. This includes, but is not limited to:

• Physicians and other Individual Providers
• Ancillaries
• Facilities
• Hospital-based
• Facility-based

• Able to work in a constant state of alertness and safe manner
• Maintain and foster a collaborative relationship with internal and external customers.
• Precisely complete all Claims and Reconsideration Service Forms according to department’s service-level agreement with Claims
• Precisely complete Credentialing, PDC, and Finance service forms according to expected levels of quality and timeliness
• Enter demographic data of new providers (as noted above) into provider network database and assign fee schedule and related pricing/contract information.
• Make necessary changes to demographic and pricing/contract data for existing providers (as noted above).
• Retrieve, validate and perform any necessary updates based on production reports for all providers as noted above. Reports include, but are not limited to:
  * Credentialing to Claims system mismatch
  * Members attached to terminated PCPs
  * Active providers with sanctions
  * Encounter errors
• Identify and report possible problems with the provider network database files.
• Participate in ongoing projects, as necessary, and in staff and/or committee meetings and training.
• File provider information and documentation in designated areas and with Document Control, if necessary
• Utilize credentialing system inquiry functions to help maintain correct data for participating providers in the provider network database.
• Perform other job duties as required by Network Management.

• High School Diploma/GED
• Database, organizational, written and verbal communication skills, and ability to work independently or as part of a team.
• Strong relational database experience, health insurance industry preferred.
• Proficient in Microsoft Outlook and working knowledge of Microsoft Excel or Access, and MS Word.

Lift and carry 25 lbs. frequent sitting/standing, frequent keyboard use,
* patient care providers may be required to perform activities specific to their role including kneeling, bending, squatting and performing CPR.

Job Description Disclaimer:
This position description provides the major duties/responsibilities, requirements and working conditions for the position. It is intended to be an accurate reflection of the current position, however management reserves the right to revise or change as necessary to meet organizational needs. Other responsibilities may be assigned when circumstances require.

Workday Day (United States of America)

Regular

Health Partners Plans, Inc.

1101 Market, Philadelphia, Pennsylvania, United States of America

Nationally ranked, Jefferson, which is principally located in the greater Philadelphia region, Lehigh Valley and Northeastern Pennsylvania and southern New Jersey, is reimagining health care and higher education to create unparalleled value. Jefferson is more…