The Provider Data Specialist is responsible for various activities related to the Provider Network database, which may include any or all of the following: database maintenance, reporting and extracting data for various reports and analyses, and initiating database improvement. Provider Data Specialists maintain standards for database integrity and quality assurance, with Provider Data Supervisor coordinates corrective activities to clean database and communicates processes with Director regarding database improvements. Other responsibilities include participating in audits and providing feedback to reduce errors and improve processes and performance, maintaining current provider data to ensure the quality of the network and resolve claim issues related to provider data.
Responsible for Provider Data Entry including data maintenance and verification
Assist with database improvements and audits
Responsbile for maintaining data integrity and quality assurance
Solve moderately complex problems and/or conduct moderately complex issues in workgroup and consulting with provider relations and contracting teams for resolution as appropriate and escalating to supervisor as needed.
Responsible for ensuring provider compliance with rules and regulations as dictated by legal, the Department of Defense, URAC, and departmental policies and procedures.
Responsible for being compliant with rules and regulations in day to day activities in regards to or as dictated by legal, CHRISTUS Integrity, the Department of Defense, and URAC, NCQA, TDI, NM which can include, but is not limited to, interactions with providers and following and adhering to Departmental as well as Organizational policies and procedures.
Respond as needed to internal and external customers regarding provider participation status.
Collaborate with and maintain open communication with all departments within CHRISTUS Health to ensure effective and efficient workflow and facilitate completion of tasks/goals
Follow the CHRISTUS Guidelines related to the Health Insurance Portability and Accountability Act (HIPAA), designed to prevent or detect unauthorized disclosure of Protected Health Information (PHI)
Assist with departmental projects as needed.
Other duties as assigned.
High School Diploma
Ability to understand provider contracts
Ability to define problems, collect data, establish facts, and draw valid conclusions.
Intermediate personal computer skills including electronic mail, record keeping, routine database activity, word processing, spreadsheet, graphics, etc.
Ability to prioritize tasks and handle multiple projects simultaneously
Ability to prioritize, organize and assignments
Ability to manage and resolve complex issues
Ability to demonstrate a high degree of personal accountability and integrity
Work with minimal guidance; seek guidance on only the most complex tasks
Must be able to commit to M-F 8a-5pm work shift
2 years or more years of experience in provider claims, data management, provider relations, preferably experience in the health insurance (HMO/PPO) industry
Current experience using a PC and keyboard
Ability to work in multiple systems
Ability to perform Data Entry and use sort/filter options in Microsoft Excel
Ability to create correspondence and work within approved company templates in Microsoft Word or Excel
Must be able to commit to M-F 8a-5pm work shift
Must be familiar with web based applications
Must be able to demonstrate professional phone skills
Understanding of provider contracts and/or contract reimbursements for data management
Our Mission: WHY WE EXIST. To extend the healing ministry of Jesus Christ. Our Core Values: WHAT WE BELIEVE IN.DIGNITY Respect for the worth of every person, recognition and commitment to the value of diverse individuals and perspectives, and special concern for the poor and underserved. INTEGRITY Honesty, justice, and consistency in all relationships. EXCELLENCE High standards of service and performance. COMPASSION Service in a spirit of empathy, love, and concern. STEWARDSHIP Wise and just use of talents and resources in a collaborative manner.Our Vision: WHAT WE ARE STRIVING TO DO. CHRISTUS HEALTH, a Catholic health ministry, will be a leader, a partner and an advocate in the creation of innovative health and wellness solutions that improve the lives of individuals and communities so that all may experience God's healing presence and love. Our Name and Symbol:WHO WE ARE. CHRISTUS is Latin for "Christ," and proclaims publicly the core of our mission. OUR NAME choice also recognizes the heritage of our two congregational sponsors, the Sisters of Charity of the Incarnate Word in Houston and San Antonio. Jesus Christ is the Incarnate Word, the Word of God made flesh. It is, theref...ore, only fitting that it is in another form of His name that our health ministries are called together. OUR SYMBOL Reflects the healing ministry of Jesus Christ - a combination of a medical cross and a religious cross. The flowing banner on the cross is a common symbol of the risen Christ, while the royal purple signifies Christ. The flowing banner also conveys a sense of motion as we move forward into a new era of service to our communities.