[Hiring] Provider Data Specialist I @CareOregon

Role Description

This position is responsible for providing product support to provider data within the QNXT module. Primary tasks include:

• Adding, maintaining, and updating provider data records
• Assistance with database integrity
• Correctly configuring provider data and contract information using written guidelines

Accurate and timely provider data plays a critical role in the success of:

• Claims payment
• OHA Health Systems (DMAP) and CMS encounter data submission
• PCP assignment
• Authorization processing
• Credentialing
• IRS reporting
• Regulatory projects
• The provider directory

Estimated Hiring Range: $23.28 - $28.45

Bonus Target: Bonus - SIP Target, 5% Annual

Priority will be given to candidates residing in Oregon and Southwest Washington.

Current CareOregon Employees: Please use the internal Workday site to submit an application for this job.

Qualifications

• Minimum 1 year of experience with data configuration, data management, credentialing, or claims management
• Preferred: 2 years of experience working in health care/insurance
• Experience with managed care and/or project participation

Requirements

• Perform accurate and timely data entry into provider database, following Provider Data policies and procedures
• Provide data management and process knowledge to the organization; assist with projects
• Investigate and resolve provider and provider contract pending claims as requested by more advanced Provider Data staff; apply claims policies and procedures
• Monitor call and email queues by reviewing requests and communicating clearly and timely with contracted provider offices and internal customers
• Research demographic and affiliations changes; make updates to provider database reflecting new information once validated
• Manage monthly provider rosters received from contracted hospital systems and IPAs by investigating changes and validating information prior to updating QNXT
• Consult with advanced Provider Data staff to clarify information
• Complete provider database projects resulting from contracting, configuration, or regulatory changes
• Sort incoming faxes, PIVs and distribute according to assignments
• Maintain SharePoint libraries according to unit protocols
• Enroll providers with OHA Health Systems using MMIS web enrollment portal
• Reroute critical pieces of return mail including 1099s, live checks and remittance advice by investigating demographic discrepancies and reflecting changes in QNXT
• Troubleshoot and investigate provider portal issues when they arise
• Troubleshoot provider setup to support provider reporting, directory, and claims operation
• Perform testing of new software versions
• Data validation through license boards, IRS, NPPES, and other third-party verification
• Resolve data errors through troubleshooter processes and internal audits

Benefits

• Competitive pay
• Bonus opportunity
• Comprehensive benefits package including 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, and multiple supplemental benefits
• Strong retirement plan with employer contributions
• PTO and Paid State Sick Time based on hours worked/scheduled hours
• Paid holidays, volunteer time, jury duty, bereavement leave, and more

Company Description

CareOregon is an equal opportunity employer. The organization selects the best individual for the job based upon job related qualifications, regardless of race, color, religion, sexual orientation, national origin, gender, gender identity, gender expression, genetic information, age, veteran status, ancestry, marital status or disability.

The organization will make a reasonable accommodation to known physical or mental limitations of a qualified applicant or employee with a disability unless the accommodation will impose an undue hardship on the operation of our organization.