Provider Data Specialist I

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

📋 Description

• Deliver product support for provider data within the QNXT module.

• Add, maintain, and update records pertaining to provider data.

• Aid in ensuring database integrity while configuring provider data and contract information according to established guidelines.

• Conduct precise and timely data entry in accordance with Provider Data policies and procedures.

• Offer data management expertise and process knowledge while assisting with various projects.

• Investigate and resolve pending claims related to providers and provider contracts.

• Monitor email and call queues, communicating with contracted provider offices and internal clients.

• Research demographic and affiliation changes, updating the provider database after verification.

• Manage monthly provider rosters from associated hospital systems and IPAs.

• Execute provider database projects triggered by contracting, configuration, or regulatory modifications.

• Sort and distribute incoming faxes and PIVs according to designated assignments.

• Maintain SharePoint libraries effectively.

• Enroll providers with OHA Health Systems via the MMIS web enrollment portal.

• Redirect critical return mail, including 1099s, live checks, and remittance advice.

• Troubleshoot issues related to the provider portal.

• Address provider setup problems impacting reporting, directories, and claims operations.

• Test new versions of software.

• Validate data through various sources such as license boards, IRS, NPPES, and other third-party verifications.

• Resolve data discrepancies through troubleshooting processes and internal audits.

⛳️ Requirements

• At least 1 year of experience in data configuration, management, credentialing, or claims management.

• Familiarity with relational databases.

• General understanding of or willingness to learn managed care and Oregon Health Plan concepts.

• Proficient in Microsoft Office Suite, particularly Excel.

• Ability to learn and efficiently navigate claims processing technologies such as QNXT and Facets.

• Capability to learn and effectively use document management and collaboration tools like SharePoint and Office 365.

• Strong adherence to policies and procedures.

• Skill in troubleshooting data integrity issues and identifying their root causes.

• Competence in authoring and maintaining process documentation.

• Excellent listening, verbal, written, and customer service communication skills.

• Ability to convey instructions and communicate clearly with non-technical personnel.

• Capacity to manage multiple priorities and requests simultaneously.

• Keen attention to detail and deadlines.

• Ability to cultivate analytical and research skills.

• Proficient in working effectively with diverse individuals and groups.

• Ability to perform repetitive finger and wrist movements and read for at least 6 hours/day.

• Ability to hear and speak clearly for a minimum of 3–6 hours/day.

🏝️ Benefits

• Bonus - SIP Target, 5% Annual.

• Comprehensive 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.

• Option for remote work from home.