Putting members first since 1933.
Provider Network Data Maintenance Associate
Location
North Carolina
Posted
2 days ago
Salary
$35.5K - $56.9K / year
Seniority
Mid Level
Job Description
Provider Network Data Maintenance Associate
PacificSource Health Plans
• Accurately and promptly enter and update provider demographic, credentialing, and contract information in PacificSource systems for new and re-credentialed network providers • Process provider additions, terminations, and changes in a timely manner to maintain data integrity and ensure accurate contract rows are added for correct claims payments • Perform regular audits of provider data to ensure accuracy, compliance with internal standards, regulatory requirements, and support ongoing maintenance and data integrity of provider information • Assist in the management of provider directories, ensuring they are current, accurate, and meet the needs of members • Verify licensure, Medicare, and Medicaid eligibility using compliance-approved tools • Support the monitoring and maintenance of provider records for compliance with organizational policies, procedures, and contracting regulations • Collaborate with Provider Relations, Credentialing, Contracting, and other internal teams to resolve provider data issues • Communicate with providers to obtain necessary documentation or clarify discrepancies in data • Provide support and assistance to other team members as needed • Identify opportunities for process improvements related to provider data management • Assist in the development and implementation of best practices for provider data entry and maintenance
Job Requirements
- A minimum of 2 years of experience in an office environment is required
- Preferred experience in healthcare data management, network operations or data analysis
- High School Diploma or equivalent required, Associate’s or Bachelor’s degree preferred
- Fast and accurate data entry skills
- Self-motivated
- Able to learn and be trained on new systems, databases, and applications
- Effective written and oral communication
- Proficient computer skills, typing, and 10-key required
- Medical terminology, CPT/ICD-10 coding preferred
Benefits
- Flexible telecommute policy
- Medical, vision, and dental insurance
- Incentive program
- Paid time off and holidays
- 401(k) plan
- Volunteer opportunities
- Tuition reimbursement and training
- Life insurance
- Options such as a flexible spending account
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