Provider Data Lead Representative

This is a fully remote position, open to applicants in United States.

📋 Description

• Execute the addition, termination, and updating of provider data.

• Carry out data remediation processes in HCPM, CPF, and Facets.

• Implement updates as identified through quality audits and performance evaluations.

• Apply contractual terms and adhere to network business rules.

• Identify operational risks and issues during data loading processes and take necessary corrective actions.

• Validate data accuracy across various systems and ensure proper transmission to downstream platforms.

• Conduct root cause analyses and implement effective solutions.

• Analyze intake requests from matrix partners and perform updates at the provider, network, or criteria level.

• Maintain production and quality standards, ensuring timely documentation in the Daily Activity Log.

• Support system enhancement initiatives through testing, validation, and checkout activities.

• Collaborate with the team while remaining accountable for individual outcomes.

⛳️ Requirements

• A high school diploma or GED is required; some college coursework is preferred.

• A minimum of 2 years of demonstrated proficiency in using CPF and HCPM is required.

• Experience with Proclaim and Facets is preferred.

• A strong understanding of data flow and the impacts on downstream systems is essential.

• Knowledge of provider structures, including Practitioners, Groups, Facilities, and Ancillaries is required.

• A solid understanding of contracts, networks, and applicable Market Guidebook standards is highly preferred.

• Working knowledge of DAL, Inventory Manager, ETQS, Activity Manager, Provider Manager, Renaissance, and Knowledge Exchange is highly preferred.

• Must have cable broadband or fiber optic internet service with a minimum of 10Mbps download and 5Mbps upload speeds while working from home.

🏝️ Benefits

• Eligibility for an annual bonus plan.

• Medical, vision, and dental benefits begin on the first day of employment.

• Access to well-being and behavioral health programs.

• 401(k) retirement plan.

• Company-paid life insurance.

• Tuition reimbursement opportunities.

• A minimum of 18 days of paid time off each year.

• Paid holidays.

• Leaves of absence available.

• Work-at-home arrangements.

• Requirement for cable broadband or fiber optic internet service with at least 10Mbps download and 5Mbps upload speeds.