Provider Network Data Maintenance Associate

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🔥 22 minutes ago

🌲 North Carolina – Remote

🌲 North Carolina – Remote

💵 $35.5k - $56.9k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

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PacificSource Health Plans

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1933

⚕️ Healthcare Insurance

💸 Finance

🧘 Wellness

Healthcare Insurance • Finance • Wellness

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

• Accurately and promptly enter and update provider demographic, credentialing, and contract information in PacificSource systems for new and re-credentialed network providers • 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 • 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 • Communicate with providers to obtain necessary documentation or clarify discrepancies in data • Provide support and assistance to other team members as needed • Identify opportunities for process improvements related to provider data management • Assist in the development and implementation of best practices for provider data entry and maintenance

🎯 Requirements

• A minimum of 2 years of experience in an office environment is required • Preferred experience in healthcare data management, network operations or data analysis • High School Diploma or equivalent required, Associate’s or Bachelor’s degree preferred • 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 • Medical terminology, CPT/ICD-10 coding preferred

🏖️ Benefits

• Flexible telecommute policy • Medical, vision, and dental insurance • Incentive program • Paid time off and holidays • 401(k) plan • Volunteer opportunities • Tuition reimbursement and training • Life insurance • Options such as a flexible spending account