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PacificSource Health Plans · 12 hours ago

Provider Network Data Maintenance Associate

Springfield, OR

Full-time

Onsite

Entry Level

$36K/yr - $57K/yr

2+ years exp

PacificSource Health Plans is dedicated to helping members access quality, affordable care. The Provider Network Data Maintenance Associate is responsible for maintaining the accuracy and integrity of provider data, ensuring compliance with regulatory requirements, and supporting various teams in managing provider-related information.

CommunitiesCustomer ServiceNon Profit

Responsibilities

Accurately and promptly enter and update provider demographic, credentialing, and contract information in PacificSource systems for new and re-credentialed network providers, meeting department service level expectations

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, ensuring provider data meets all regulatory and accreditation standards, including state and federal requirements

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, and research and respond to detailed provider inquiry issues routed from customer/provider service departments

Communicate with providers to obtain necessary documentation or clarify discrepancies in data, ensuring positive and effective working relationships

Provide support and assistance to other team members as needed to ensure the overall effectiveness of the provider network operations

Identify opportunities for process improvements related to provider data management, maintenance, and contribute to quality assurance initiatives to continuously improve data accuracy and process efficiency

Assist in the development and implementation of best practices for provider data entry and maintenance, and participate in projects related to provider network expansion, system upgrades, or regulatory changes

Maintain positive and effective working relationships with team members and other departments

Meet department and company performance and attendance expectations, maintaining a high level of data accuracy and productivity

Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information

Perform other duties as assigned, contributing to the overall success of the Provider Network Department

Qualification

Healthcare data managementProvider credentialingRegulatory complianceData entry skillsMedical terminologyEffective communicationOrganizational skillsProblem solvingTeamwork

Required

A minimum of 2 years of experience in an office environment is required

High School Diploma or equivalent required

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

Preferred

Preferred experience in healthcare data management, network operations or data analysis

Preferred familiarity with provider network operations included, but not limited to, provider credentialing, healthcare regulatory requirements, contracting or reimbursement processes

Associate's or Bachelor's degree preferred

Medical terminology, CPT/ICD-10 coding preferred