Provider Data Specialist I

🔥 7 hours ago

🌲 Oregon – Remote

🌲 Oregon – Remote

💵 $23 - $28 / hour

⏰ Full Time

🟢 Junior

🚫👨‍🎓 No degree required

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👻 Ghost score 0%

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CareOregon

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 1994

🏥 Healthcare

📦 Logistics

🛡️ Insurance

Healthcare • Logistics • Insurance

CareOregon is a community-focused health plan that provides coordinated physical, behavioral, dental and social-support services to Oregon Health Plan members, serving more than 500,000 people. The organization operates provider and member portals, offers care coordination, telehealth, language and tribal services, community grants and outreach, and programs addressing social determinants of health such as housing, nutrition and transportation.

📋 Description

• Provide product support for provider data within the QNXT module • Add, maintain, and update provider data records • Assist with database integrity and configure provider data and contract information using written guidelines • Perform accurate and timely data entry following Provider Data policies and procedures • Provide data management and process knowledge and assist with projects • Investigate and resolve provider and provider contract pending claims • Monitor call and email queues and communicate with contracted provider offices and internal customers • Research demographic and affiliation changes and update the provider database after validation • Manage monthly provider rosters from contracted hospital systems and IPAs • Complete provider database projects resulting from contracting, configuration, or regulatory changes • Sort incoming faxes and PIVs and distribute them according to assignments • Maintain SharePoint libraries • Enroll providers with OHA Health Systems using the MMIS web enrollment portal • Reroute critical return mail, including 1099s, live checks, and remittance advice • Troubleshoot provider portal issues • Troubleshoot provider setup supporting reporting, directories, and claims operations • Test new software versions • Validate data through license boards, IRS, NPPES, and other third-party verification • Resolve data errors through troubleshooter processes and internal audits

🎯 Requirements

• Minimum 1 year of experience with data configuration, data management, credentialing, or claims management • Familiarity with relational databases • General understanding of or ability to learn managed care and Oregon Health Plan concepts • Familiarity with Microsoft Office Suite products, especially Excel • Ability to learn and effectively navigate claims processing technologies such as QNXT and Facets • Ability to learn and effectively navigate document management and collaboration platforms such as SharePoint and Office 365 • Ability to follow policies and procedures • Ability to troubleshoot data integrity issues and identify root causes • Ability to author and maintain process documentation • Proficient listening, verbal, written, and customer service communication skills • Ability to articulate instructions and communicate effectively with non-technical staff • Ability to handle multiple priorities and requests • Attention to detail and deadlines • Ability to develop analytical and research skills • Ability to work effectively with diverse individuals and groups • Ability to see, read, and perform repetitive finger and wrist movement for at least 6 hours/day • Ability to hear and speak clearly for at least 3–6 hours/day

🏖️ Benefits

• Bonus - SIP Target, 5% Annual • Medical, dental, vision, life, AD&D, and disability insurance • Health savings account • Flexible spending account(s) • Lifestyle spending account • Employee assistance program • Wellness program • Discounts • Supplemental benefits including voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, and 529 College Savings • Retirement plan with employer contributions • Paid time off • Paid State Sick Time • Paid holidays • Volunteer time • Jury duty leave • Bereavement leave • 401(k) contributions for non-benefits-eligible employees • Remote work from home