Provider Data Specialist

Location: Tigard, OR
Date Posted: 12-31-2018
Provider Data Support Specialist – Managed Care
Tigard, OR (Southern Suburb of Portland)
** This is a Full Time, Benefits Available, CONTRACT-TO-HIRE opportunity, expected to last 3 months, or longer! **
Provider Data Specialist​ Job Summary: 
  • Ensure accuracy and timeliness of provider data.
  • Create and maintain multiple databases, including:
    • contracted provider network
    • prior authorization
    • third party liability
    • provider set ups and related corrections
  • Oversee the provider termination process including adding and changing new or existing provider records in the medical information system
  • Schedule monthly provider verifications regarding provider enrollment specifications and demographic changes
  • Update delegated provider Medicare and Medicaid documents on a monthly and ad hoc basis and ensure state compliance
  • Perform accurate and timely baseline demographic transaction updates in provider system applications in support of claim adjudication and the provider search tool.
  • Perform intake triage and respond to network inquiries.
  • Provide on-going department support and research and analysis essential to resolving concerns/issues raised by providers and other internal/external customers.
  • Review provider maintenance requests for complete and accurate information.
  • Contact providers to clarify and resolve data quality issues.
  • Identify and appropriately escalate data transaction issues that might potentially have significant contractual implications or adversely impact service levels.
  • Perform data integrity tasks by resolving inaccurate or incomplete provider data information.
  • Other projects and duties as assigned.
  • Develop a good rapport with providers and act as a liaison between the health plan, provider enrollment, the health networks, and the provider.
  • Provide appropriate reports and statistical data to other department designees for review, follow-up and resolution
  • Perform general administrative tasks in support of assigned department

Provider Data Specialist​ Background:  
  • Requires an education level of at least a high school diploma or GED; Associate’s degree is a plus.
  • Strong data entry skills required.
  • At least 1 year experience in a medical office, hospital or health plan call center, or other healthcare support role with heavy computer & database use.
  • 1-3 years experience in claims processing, provider, or credentialing preferred.
  • Strongly prefer 1 or more years at a Managed Care Organization (Health Plan, IPA/Medical Group, HMO, TPA/MSO, etc).
  • Requires basic to intermediary familiarity with Medical terminology (1-3 years direct experience).
  • Basic knowledge of health care delivery systems, Managed Care Organizations as well as Medicaid/Medicare and related state programs is needed.
  • Proficient in Microsoft Office applications, with demonstrable skills in Access and Excel, and the ability to learn new and complex computer system applications.
  • Previous experience with database management, data reporting, and data analysis preferred.
  • Must have a minimum of 30 wpm typing with a high level of accuracy. 
443.552.7423 (CALL – TEXT – FAX)
Schedule a time to talk by clicking HERE

Get Informed with
Managed Care News and more!
Sign-Up for Job Alerts
this job portal is powered by CATS