Provider Systems Data Specialist II

Overview

To maintain accurate provider information by entering necessary data elements into several database systems. Works closely with team members and other departments to research and resolve routine and complex issues and inquiries related to provider data. In addition to the Provider Systems Data Specialist I duties, the Provider Systems Data Specialist II has a higher level of experience, more autonomy, and more complex assignments.

Responsibilities

• Reviews forms for completion and researches and resolves routine discrepancies.
• Understands the complexities of the organization's core system and possesses knowledge to assess provider changes to accurately enter and maintains routine and complex provider demographic information into several database systems.
• Interacts with providers by telephone to obtain information necessary to maintain updated records.
• Monitors the help desk and researches, resolves, and responds to inquiries from other departments.
• Responds to routine telephone inquiries using an ACD telephone system.
• Recommends updates to procedures and improvements to processes.
• Prepares documents, logs, and reports using Microsoft Word and Excel.
• Files both paper and scanned documents.
• Processes contracted provider set-ups, ensuring associated Tax IDs, NPI's, affiliations and rendering providers are correctly configured.
• Enters data, including rate information relating to contracts and amendments.
• Enters data for regulatory reporting. Participates in proofing regulatory reports prior to submission.
• Resolves and processes Bug Zero assignments.
• Assists with writing and updating desk procedures.
• Interacts with delegated entities to obtain and process provider updates.
• Other duties as assigned.

Qualifications

Education and Experience

High school diploma or equivalent; 18-24 months in Provider Systems Data Specialist I position or equivalent external experience in similar position; demonstrated ability to perform all duties in the Provider Systems Data Specialist I position.

Special Skills, Licenses and Certifications

Advanced computer skills, including proficiency in multiple software applications including Microsoft Office (Word and Excel.) Experience with managed care database applications; Amisys experience preferred. Typing and 10 key accuracy. Strong organizational and multi-tasking skills. Detail oriented with ability to recognize vital information. Ability to consistently maintain quality and production standards. Excellent interpersonal and customer service skills.

Performance Based Competencies

Fast paced environment with multiple competing deadlines.

Work Environment And Physical Demands

More than 70% of work time is spent using a computer. Ability to lift, carry, or move objects of varying size, weighing up to 25 lbs. Must be able to work in a fast-paced environment and maintain courtesy and composure. Ability to function effectively with frequent interruptions.

All HealthPlan employees are expected to:

• Provide the highest possible level of service to clients;
• Promote teamwork and cooperative effort among employees;
• Maintain safe practices; and
• Abide by the HealthPlan’s policies and procedures, as they may from time to time be updated.

HIRING RANGE:

$ 27.62 - $ 33.84

IMPORTANT DISCLAIMER NOTICE

The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive or definitive of the tasks that an employee may be required to perform. The employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change.