Job Description:

Job Description

JOB SUMMARY: This role maintains provider demographic data within the organizationally utilized database environment. The incumbent will regularly add and edit participating provider records in accordance with organizational and network processing guidelines. The driven individual will also coordinate communication with designated provider groups, and will create and implement electronic provider rosters on behalf of the department.

JOB ROLES AND RESPONSIBILITIES:

1. Analyze, research, and input relevant data for providers added to the organization's network through individual contracts, facility/ancillary contracts and/or newly acquired group contracts. Maintain changes to current provider files including provider terminations. Provider records to be updated include but are not limited to: practitioner, facility, ancillary, and group records.

2. Obtain missing data and update provider profiles specific to provider directory and/or client data extracts.

3. Research and respond to all adhoc requests (status checks) from both internal and external customers. Fully update provider profiles as appropriate assuring continual adherence to established operational guidelines.

4. Utilize organizationally embraced technologies to build provider group rosters for use within the organization's database environment.

5. Participate in routine review of department processes and procedures to grasp an expert understanding of the impact process updates have on the organization's internal and external customers. Provide feedback on potential improvement opportunities to management as appropriate.

6. Liaise amongst internal and external partners in regards to the solicitation of demographic data and resolution of inaccuracies as necessary.

7. Foster an environment encouraging open communication, knowledge sharing, and process improvement opportunities on behalf of the department on an internal and external basis.

8. Identify issues that require additional investigation and evaluation, validate discrepancies incurred, and ensure appropriate follow up. Partner with management team to identify and implement an appropriate disposition to discrepancies and issues as they occur.

9. Complete data validation processes specific to provider data received to ensure accuracy prior to entry.

10. Verify, research, and respond to telephone inquiries and written inquires, from providers and other departments, pertaining to provider participation in a professional and courteous manner. Complete special projects as assigned by management this may include but is not limited to both telephonic and electronic investigative work.

11. Ensure systematic data oriented efforts to improve consumer and/or client services. 100% of this job is related to QM activities.

12. Partner cross-functionally as necessary to ensure accurate and efficient disposition of data investigations and maintenance work.

13. Collaborate, coordinate, and communicate across disciplines and departments.

14. Ensure compliance with HIPAA regulations and requirements.

15. Demonstrate Company's Core Competencies and values held within.

16. The position responsibilities outlined above are in no way to be construed as all encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned as necessary.

JOB SCOPE:

The incumbent works under general supervision in a self-directed and results oriented manner. The incumbent works within established standards and procedures, relying on a broad range of knowledge gained through experience to complete job responsibilities. Work involves support tasks with some of complex issues referred to supervisor. This job does not directly supervise other personnel.

Requirements

JOB REQUIREMENTS (Education, Experience, and Training):

* Minimum High School Diploma and 5 years' relevant experience; Bachelors' degree in a related field is preferred

* Communication (written, verbal, listening) organization, telephone, interpersonal, analytical and data entry skills

* Ability to be detail oriented

* Ability to work independently and adapt to various tasks

* Ability to meet quality and production goals

* Ability to use software, hardware and peripherals related to job responsibilities including MS Office products

* Ability to maintain professional communications with external consumers

* Required licensures, professional certifications, and/or Board certifications as applicable

* Individual in this position must be able to work in a standard office environment which requires sitting and viewing monitor(s) for extended periods of time, operating standard office equipment such as, but not limited to, a keyboard, copier and telephone

As an Equal Opportunity Employer, the Company will provide equal consideration to all employees and job candidates without regard to sex, age, race, marital status, sexual orientation, religion, national origin, citizenship status, physical or mental disability, political affiliation, service in the Armed Forces of the United States, or any other characteristic protected by federal, state, or local law.

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