Provider Data Specialist

Provider Analytics & Reporting
Work hours: 40/week
Temp but could potentially be Temp-to-hire
Start date: Immediately
Length of assignment: 06/30/2023 (possible extension)
Location: Hybrid (2x weekly in office starting in April)
Bill Rate: $50.00 (flexible with experience) - ideal pay rate to be at 28% GM - $30.80
Specific Skills Needed: Top 3-5 mandatory and/or minimum requirements: SQL, R, Excel, experience with complex data cleansing, integration and reconciliation, experience with process automation
Top 3-5 desirable attributes/qualifications?: Superior communication, critical thinking, teamwork and project management skills, and strong learning agility

GENERAL FUNCTION
The Provider Data Specialist provides exceptional service and support to all EyeMed providers/locations through execution of provider/location database requests within established performance metrics.

MAJOR DUTIES AND RESPONSIBILITIES

• Receives, researches and processes provider/location requests related to additions, changes and terminations and ensures all requests are logged in appropriate database for performance measurement.
• Evaluates, researches and resolves complex provider data maintenance requests and issues. Understands the systems, business process and provider impact of alternative set-ups.
• Evaluates, researches and resolves credentialing requests and issues. Understands the credentialing process and provider impacts of the credentialing process.
• Assists management with database/data integrity issue research and recommends resolutions. Identifies trends related to data structure/set up and reports trends with proposed solutions to management.
• Identifies opportunities to improve processes to ensure efficient turnaround of issues and meets and exceeds established deadlines and performance standards.
• Develops and maintains departmental policies and procedures documentation related to provider data set up.
• Responds to telephone calls, emails, and written requests from providers/locations as well as internal EyeMed departments related to provider/location set up in system.
• Ensures efficient, accurate and timely responses to provider requests related to participation in the EyeMed panel.
• Educates providers on plan participation, eligibility and authorization processes through use of the Web or IVR.
• Educates providers regarding contractual obligations.
• Identifies training opportunities for EyeMed Customer Care Center to ensure more accurate responses to provider questions.
• Distributes provider/location contracts and follows up to ensure all appropriate contracts are executed prior to provider/location participation on a panel.
• Develops and maintains direct relationships with claims department to coordinate return checks and ensure providers/location payment information is maintained to ensure efficient payments to providers.
• Assists in ensuring all appropriate documentation is maintained in document management application.
• Meets performance and quality metrics.
• Implements/participates in other provider relations team projects as requested.

PREFERRED QUALIFICATIONS

• Associate or Bachelor"s Degree
• Customer service and/or data analysis experience
• Experience within health care industry
• Problem solving skills/decision making abilities
• Analytical ability in understanding business processes/impact of decisions
• Strong critical thinking skills
• Developed oral/written communication skills
• Ability to handle escalated provider issues, including direct provider calls

Salary : $50 - $0