PROVIDER NETWORK DATA SPECIALIST - PROVIDER NETWORK SOLUTIONS

PROVIDER NETWORK DATA SPECIALIST - PROVIDER NETWORK SOLUTIONS

20 Sep 2024
New Mexico, Albuquerque 00000 Albuquerque USA

PROVIDER NETWORK DATA SPECIALIST - PROVIDER NETWORK SOLUTIONS

Vacancy expired!

Job Description Type of Opportunity: Full Time FTE: 1.000000 Exempt: Yes Work Schedule: Weekday Schedule Monday-FridaySummary:Performs research and analysis to ensure accurate provider data. Primary responsibilities include data collection, analysis, engagement with provider community and reach out to ensure data integrity is maintained in system. Responsible for researching and coordinating with internal staff to ensure data is collected, maintained, and accurate. Also, acts as a liaison between Provider, Provider Network Management staff, Provider Configuration, Member Education and Engagement, External Provider Automation, Decision Support and other related departments to ensure data integrity of provider information and for process improvement and error resolution related to the provider data and provider directories Responsibilities:References online policies and procedures to ensure accurate and consistent task completion. References online policies and procedures to ensure timelines and requirements are met. Plays an integral role in provider directory data validation process including review and verification of provider data. Researches and analyzes provider data to ensure that the online provider directories are accurate and meet the standards set for by regulators (i.e. NCQA, HSD, CMS).Enters data proficiently to ensure accuracy from provider applications into database, interpreting or adapting data to conform to defined data field uses.Sends out various provider notifications as well, assisting in developing new reporting and corresponding formats to ensure that data is current.Assists in developing and revising policies and procedures, criteria and audit tools to ensure compliance with national, federal and state regulatory agencies related to the provider directories.Responds effectively to high priority tasks while maintaining daily activities.Collaborates with multiple internal departments, vendors, and customers to ensure reliability, integrity and accuracy of provider data. Accountable for monitoring the business processes related to the accuracy of provider data. Must communicate and actively monitor the regulatory and legal obligations of accurate provider data, while understanding the impact to the health plan while initiating necessary activities to ensure complianceAbility to work on complex problems and provide guidance to create solutions that are innovative and more sophisticated in nature, achieving quality and work / process improvements.Ability to effectively express technical and non-technical concepts both verbally and in writing clearly, concisely, and target communication to both technical and non-technical audiences.Ability to work in a team environment, take and give direction and follow through, compromise, negotiate and achieve consensus decisions, support consensus decisions, be flexible and adaptable to changes in assignments and the work environment, work independently, manage time efficiently and multi-task effectively.Participates on process improvement teams (may be cross-functional). Develops documentation in support of the process improvement effort.Works effectively with cross-functional departments and external customers.Performs other functions as required.Requirements:A minimum of one year experience required in healthcare. Demonstrated ability to communicate effectively in person, via telephone and in writing. Requires strong organizational skills and the ability to work under pressure with minimal supervision. Microsoft Word, Access and Excel experience required. Education:Essential:

High School Diploma or GED

Competencies and skills:Nonessential:

SKILL-Microsoft Office

Planning and coordinating organizational change

Anticipating & Addressing Customer Needs

Educating Employees, Customers & Transferring Knowledge

Functioning as an Effective Contingent Member

Diagnosing & Resolving Problems

Acquiring & Applying Superior Skills to achieve Quality Outcomes

Functioning as an Effective Team Member

Organizational Skills

SKILL-Ability to deal with all levels of staff and management within the organization, board members, as well as the public, under highly stressful conditions.

SKILL-Demonstrated ability to communicate effectively in person and via telephone with members, employer groups, brokers, physicians, and physician office staff using strong dialogue and customer service competencies.

SKILL-Able to work under limited supervision, self manage work time and projects, resolve issues with minimal assistance.

SKILL-Written communication

Benefits Benefits are effective day-one (for .45 FTE and above) and include:

Competitive salaries

Full medical, dental and vision insurance

Flexible spending accounts (FSAs)

Free wellness programs

Paid time off (PTO)

Retirement plans, including matching employer contributions

Continuing education and career development opportunities

Life insurance and short/long term disability programs

About Us Presbyterian Healthcare Services is a locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, it is the state's largest private employer with approximately 11,000 employees.Presbyterian's story is really the story of the remarkable people who have chosen to work here. Starting with Reverend Cooper who began our journey in 1908, the hard work of thousands of physicians, employees, board members, and other volunteers brought Presbyterian from a tiny tuberculosis sanatorium to a statewide healthcare system, serving more than 700,000 New Mexicans. We are part of New Mexico's history - and committed to its future. That is why we will continue to work just as hard and care just as deeply to serve New Mexico for years to come. About New Mexico New Mexico's unique blend of Spanish, Mexican and Native American influences contribute to a culturally rich lifestyle. Add in Albuquerque's International Balloon Fiesta, Los Alamos' nuclear scientists, Roswell's visitors from outer space, and Santa Fe's artists, and you get an eclectic mix of people, places and experiences that make this state great. Cities in New Mexico are continually ranked among the nation's best places to work and live by Forbes magazine, Kiplinger's Personal Finance, and other corporate and government relocation managers like Worldwide ERC. New Mexico offers endless recreational opportunities to explore, and enjoy an active lifestyle. Venture off the beaten path, challenge your body in the elements, or open yourself up to the expansive sky. From hiking, golfing and biking to skiing, snowboarding and boating, it's all available among our beautiful wonders of the west. AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses. Requisition ID: 2019-11460

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Job Details

  • ID
    JC2719020
  • State
  • City
  • Full-time
  • Salary
    N/A
  • Hiring Company
    Presbyterian Healthcare Services
  • Date
    2019-09-20
  • Deadline
    2019-11-18
  • Category

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