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Provider Data Management Specialist
Location:
Brookfield, WI
Description:
Provider Data Management Specialist About us Common Ground Healthcare Cooperative is a "who" not a "what." As a cooperative, we are thousands of Wisconsin residents buying health insurance together, supported by a staff focused on providing the best possible service to our members. We are a not-for-profit cooperative, governed by a Board of Directors made up of members who purchase our health insurance. Any earnings are returned to our members in the form of lower prices and better services. Our Culture We are here because we can make a difference in the lives of others. We believe that serving our community is meaningful work and we hold it in the highest regard. We are vibrant, dynamic, and value-focused individuals who welcome different points of view, perspectives, and thoughtful solutions to challenges. We encourage teamwork, integrity, mutual respect, honesty and doing the right thing. We know the importance of showing appreciation for a job well done, celebrate our achievements, and make room for fun and laughter in the workplace. Our Job We are continuously improving our efforts to serve our members and lower their overall healthcare cost through our three key pillars: Advocacy Partnership Innovation. Does this sound like a culture you'd like to be a part of? Come join a fun team of committed professionals! How You'll Make a Difference The Provider Data Management Specialist performs data entry and administrative service for the effective and efficient maintenance of CGHC's Provider Network(s). This position also provides supportive clerical functions for the Provider Relations Department. Utilize Your Skills By: Proficiently and accurately updates and maintains the provider database within the main operating system. Runs reports on a regularly scheduled basis to identify data discrepancies and make needed corrections to ensure appropriate claims processing and directory production. Performs monthly random sample audits of provider data, including telephonic outreach to provider offices to validate information. Based upon audit results, addresses any systematic discrepancies, reviews and updates workflows to rectify issues with data entry or data feeds. Performs bi-annual outreach to all independent practice locations to verify provider roster accuracy for key elements including participating provider's name, specialty, practice locations, languages spoken, hospital affiliations and accepting new patients' status. On an as needed basis, when providers terminate from our network and are eligible for Continuity of Care, runs report of impacted members requiring notification and facilitates appropriate mailings. Responsible for maintaining and updating provider financial data, including linking to appropriate fee schedules and system affiliation ID tables. Participates in Provider Onboarding meetings for implementation of new contracts and updates to existing contracts. Provides clerical and support administrative functions for the department, as well as other data entry tasks as needed. Supports the Provider Relations team by participating in special project work as directed by the department leadership. Maintains and updates the CGHC provider portal to ensure provider access to needed data as a self-serve option, reducing the need for calls into our Member Services team. Regularly compiles and sends out printable provider directories as members request them. Maintains Provider-related claims work queues, continuing to maintain claims volumes and fix errors on provider claims to enable claims to process correctly. Manages mail returns coming back from providers as undeliverable, researching correct mailing addresses and coordinating updating provider information and resending of mailings. Addresses Member Services provider tickets, answering questions from Member Services, and updating the provider database in the case that there were provider data setup errors. Collaborates with team members in completion of all tasks, working closely with other provider data management specialists and maintaining an open and communicative work environment with job sharing. All other projects and duties as assigned. What You'll Need to Bring: High School Diploma required. Proficient and accurate data entry skills Experienced user of Microsoft Office (Word, Excel). Ability to maintain departmental standards for production and quality. Able to handle multi tasks and be flexible. Ability to effectively prioritize and organize each workday. Ability to focus to detail. General Requirements: Maintains attendance according to Company standards Adheres to Company policies and procedures Ability to treat others with dignity, respect, and courtesy Ability to maintain patient, employee, and proprietary confidentiality Ability to communicate effectively in-person and in all forms of communication Promotes and maintains a flexible, cooperative, team environment. Ability to provide professional image and act professionally Ability to be flexible and adapt to changing situations We've Got You Covered CGHC offers a comprehensive benefit package and broad range of programs to meet the needs of our employees to help protect your health, wealth, and future. Job Posted by ApplicantPro
Company:
Common Ground Healthcare Cooperative
Posted:
January 25 on ApplicantList
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More About this Listing: Provider Data Management Specialist
Provider Data Management Specialist is a Executive Manager Job at Common Ground Healthcare Cooperative located in Brookfield WI. Find other listings like Provider Data Management Specialist by searching Oodle for Executive Manager Jobs.
Provider Data Management Specialist is a Executive Manager Job at Common Ground Healthcare Cooperative located in Brookfield WI. Find other listings like Provider Data Management Specialist by searching Oodle for Executive Manager Jobs.