Provider Data Specialist

Profile

We offer remote work opportunities (AK, AR, AZ, CO, FL, HI, IA, , IL, KS, LA, MD, MN, MO, MT, NE, NV, NM, NC, ND, OK, OR, SC, SD, TN, TX, UT, VA/DC, WA, WI & WY only).

Our Department of Defense contract requires US citizenship and a favorably adjudicated DOD background investigation for this position.

Veterans, Reservists, Guardsmen and military family members are encouraged to apply!

Ensures accurate, timely maintenance and synchronization of critical provider data across all provider databases and systems. Accesses and utilizes multiple software applications. Applies business rules and knowledge of Provider contract language, pricing and reimbursement methodologies to each database/system to validate Provider information across systems. Communicates with internal and external clients by phone and email to clarify data and follow‑up on issues, while working under timeline, accuracy, and production targets.

Requires the ability to manage a large amount of complex information and must be able to communicate clearly and draw sound conclusions. Supports the maintenance of accurate, up‑to‑date provider data to include updates, changes, additions and terminations for assigned files.

• High School Diploma or GED
• U.S. Citizenship
• Must be able to receive a favorable Interim and adjudicated final Department of Defense (DOD) background investigation
• One year experience in a customer service role or administrative support work requiring data entry work
• Proficiency in using Microsoft Office products and the Internet

• 2 years of data entry experience
• Healthcare industry experience, including knowledge of health services

• Process provider data inventory within expected timeline while meeting accuracy and production targets.
• Identify, research, and analyze issues received to determine appropriate handling. Resolve provider data correction requests in a specified time frame. Manage daily follow up of Provider data correction requests and resolve all issues to ensure databases are current and accurate.
• Maintain and process reimbursement terms to ensure correct claims payment and downstream processing.
• Review Provider contract language and identify when the contract is out of compliance. Process Provider contracts, run reports and respond to inquiries regarding contract compliance issues; image and index contracts and return images to network subcontractors. Conduct quality assurance activities to ensure image quality and completion of image activities.
• Support requests for assistance and research issues using various resources including online searches and phone calls.
• Communicate clearly through both written and verbal forms of communication and follow up with various parties to ensure tasks are completed within the allotted timeline or issues are escalated appropriately.
• Coordinate with internal departments for provider database related issues.
• Perform all other related duties as assigned by supervisor.
• Regular and reliable attendance is required.

Commitment to Task: Ability to conform to established policies and procedures; exhibit high motivation.

Communication / People

Skills:

Ability to influence or persuade others under positive or negative circumstances; adapt to unique styles; listen critically; collaborate.

Computer Literacy: Ability to function in a multi‑system Microsoft environment using Word, Excel, Outlook, Tri West Intranet, the Internet, and department software applications.

Organizational

Skills:

Ability to multi‑task, adjust to priorities and learn new systems, within the time constraints and with available resources; must be detail‑oriented.

Problem Solving / Analysis: Ability to solve problems through systematic analysis of processes with sound judgment; has a realistic understanding of relevant issues.

Technical

Skills:

Proficient with key databases, including Fox Pro, Claims Systems, Medical Management Systems, and Provider Data Management Systems; working knowledge of VA policies and procedures, current knowledge of claims, reimbursement methodology; healthcare or managed care experience.

• Availability to…