Description
Summary: The Provider Data Specialist is responsible for identifying system issues, training the team, being the subject matter expert, and providing defect resolution analysis via claims and system analysis in support of the Benefits Configuration and Provider Data departments. The Lead collaborates closely with the Supervisor and team to ensure that data sets are analyzed, and the research is reported to all affected areas for fast resolution and claims reprocessing. Responsibilities: * Responsible for Provider Data Entry including data maintenance and verification
* Assist with database improvements and audits
* Responsible 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 regard 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 Requirements:
- 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 familiar with web-based applications
- Must be able to demonstrate professional phone skills
- Understanding of provider contracts and/or contract reimbursements for data management
Work Type: Full Time
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Christus Health
Apr 30, 2025