Provider Network Data Maintenance Associate

Job not on LinkedIn

🔥 13 minutes ago

🏰 Missouri – Remote

🏰 Missouri – Remote

💵 $35.5k - $56.9k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

👻 Ghost score 0%

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PacificSource Health Plans

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1933

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

PacificSource Health Plans is a healthcare provider that offers a range of health insurance solutions, including plans for individuals, families, and employers. Their offerings include Medicare and Medicaid plans, dental coverage, and administrative services for small and large groups. Committed to member care, PacificSource emphasizes customer service and provides various resources for health management, including mental health support and wellness programs.

📋 Description

• Enter and update provider demographic, credentialing, and contract information in PacificSource systems • Process provider additions, terminations, and changes to maintain data integrity and accurate contract rows for claims payments • Audit provider data for accuracy, compliance, internal standards, and regulatory requirements • Assist with provider directory management • Verify licensure, Medicare, and Medicaid eligibility using compliance-approved tools • Monitor and maintain provider records for organizational and contracting compliance • Collaborate with Provider Relations, Credentialing, Contracting, and other internal teams to resolve provider data issues • Research and respond to detailed provider inquiries routed from customer/provider service departments • Communicate with providers to obtain documentation or clarify data discrepancies • Support team members and provider network operations • Identify process improvements and contribute to quality assurance initiatives • Assist in developing and implementing provider data entry and maintenance best practices • Participate in projects involving provider network expansion, system upgrades, or regulatory changes • Maintain positive working relationships with team members and departments • Meet department and company performance and attendance expectations • Follow PacificSource privacy policy and HIPAA requirements • Perform other duties as assigned

🎯 Requirements

• Minimum of 2 years of experience in an office environment • High School Diploma or equivalent required • Fast and accurate data entry skills • Ability to learn and be trained on new systems, databases, and applications • Effective written and oral communication • Proficient computer skills, typing, and 10-key required • Ability to read and comprehend both written and spoken English • Ability to communicate clearly and effectively • Medical terminology and CPT/ICD-10 coding preferred • Preferred experience in healthcare data management, network operations, or data analysis • Preferred familiarity with provider credentialing, healthcare regulatory requirements, contracting, or reimbursement processes • Work inside in a general office setting with ergonomically configured equipment • Travel may be required 5% of the time for training and/or external meetings • Must follow privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information

🏖️ Benefits

• Work-from-home location (WFH: MO) • Training and/or external meeting opportunities • Equal opportunity employment • At-will employment

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