PRINCIPAL RESPONSIBILITIES:

The Provider Data Coordinator I, under general supervision from the Supervisor, Network Data Validation will verify, change and update provider data for accuracy. Provider data will be entered into multiple systems including but not limited to HealthSuite, Excel spreadsheets, and the Provider Repository.

Principal responsibilities include:

• Update provider terminations, changes, additions, and contracts into various claims processing systems.
• Verify provider data quality, including demographic and billing information.
• Coordinate W-9 additions and changes; make outreach calls, scan to file, update system(s), and forward to appropriate departments.
• Update "Provider Not Found" physician demographic and contracting information into HealthSuite and/or Provider Repository.
• Resolve various Claims issues including adding new vendor records and updating of existing contract records.
• Provide support to the Authorizations department to add and/or update providers into various systems so authorizations will link appropriately for claims payment.
• Data owner of the Provider Directory database.
• Load all newly credentialed and re-credentialed providers to various databases.
• Make phone calls to providers directly and note any demographic changes into Excel spreadsheets by transcribing verified changes from call sheets.
• Scan necessary provider documentation and file in contract folders.
• Participate in the pulling of necessary documents and contracts for audits.
• Accurate and timely completion of reports and projects.
• Collaborate with the entire Data team to identify staff training and development needs for improved performance.
• Manage assigned work within turn-around timeframes and update accurately.
• Maintain an average of 95% for overall quality assurance.
• Support continuous improvement of Data team effectiveness.
• Complete other duties and special projects as assigned.

ESSENTIAL FUNCTIONS OF THE JOB

• Telephone: Make, receive, and document telephone calls from providers to verify demographic information.
• Transcription: Transcribe verified changes accurately and ensure data integrity.
• Computer: Enter verified changes into databases, claims processing systems and spreadsheets.
• Filing: Maintain files, records, contracts, including policies and procedures for the department in a timely fashion.
• Comply with the organization's Code of Conduct, all regulatory and contractual requirements, organizational policies, procedures, and internal controls.

PHYSICAL REQUIREMENTS

• Constant and close visual work at desk or computer.
• Constant sitting and working at desk.
• Constant data entry using keyboard and/or mouse.
• Constant use of telephone headset.
• Frequent verbal and written communication with staff and other business associates by telephone, correspondence, or in person.
• Frequent lifting of folders and objects weighing between 0 and 30 lbs.
• Frequent walking and standing.

Number of Employees Supervised: 0

MINIMUM QUALIFICATIONS:

EDUCATION OR TRAINING EQUIVALENT TO:

• High School diploma required.
• One year of data entry experience (or equivalents).
• Six months of experience in managed health care setting; Medicare/Medi-Cal experience preferred.
• Demonstrated track record of schedule adherence (punctuality and attendance) measured by the timecard tracking system.

SPECIAL QUALIFICATIONS (SKILLS, ABILITIES, LICENSE):

• Customer service oriented and resourceful.
• Ability to plan and execute projects independently.
• Ability to type 50 wpm.
• Ability to work in a multidisciplinary company.
• Proficient in use of computer software programs including entire Microsoft Office Suite of software (Word, Excel, PowerPoint, Access) and Microsoft Outlook.
• Ability to work in cooperation with others.
• Ability to communicate effectively, both verbally and in writing.
• Customer service background.
• Ability to work with others while completing multiple tasks simultaneously and successfully.
• Knowledge of HealthSuite and Provider Repository preferred.

SALARY RANGE $ 22.00 - $33.01 HOURLY

The Alliance is an equal opportunity employer and makes employment decisions on the basis of qualifications and merit. We strive to have the best qualified person in every job. Our policy prohibits unlawful discrimination based on race, color, creed, gender, religion, veteran status, marital status, registered domestic partner status, age, national origin or ancestry, physical or mental disability, medical condition, genetic characteristic, sexual orientation, gender identity or expression, or any other consideration made unlawful by federal, state, or local laws. M/F/Vets/Disabled.