Provider Data Specialist Job Description

Provider Data Specialist Job Description

161 votes for Provider Data Specialist
Provider data specialist provides education to the management staff, Medical Director’s, Provider Enrollment Assistant, and Provider Enrollment Representatives I & II pertaining to changes in provider enrollment rules and regulations.

Provider Data Specialist Duties & Responsibilities

To write an effective provider data specialist job description, begin by listing detailed duties, responsibilities and expectations. We have included provider data specialist job description templates that you can modify and use.

Sample responsibilities for this position include:

Trains other staff on project spreadsheets, the process of de-duplicating pairs, and reviewing records according to project procedures
Writes procedures for points of contact to follow when conducting electronic transfers for the project
Resolves provider database issues such as addresses, user warnings, and makes corrections as needed
Candidate should be able to work independently with little instruction
Performs accurate and timely data entry
Conducts true “root cause analysis” on issues
Listens actively and checks for understanding
Assists in ensuring that Provider Directories (paper and online look up) and regulatory requirements
Keeper of ORS IDS and information for the Gatekeeper program the OTC Routing assignments
Will set up new provider records and updating provider records

Provider Data Specialist Qualifications

Qualifications for a job description may include education, certification, and experience.

Education for Provider Data Specialist

Typically a job would require a certain level of education.

Employers hiring for the provider data specialist job most commonly would prefer for their future employee to have a relevant degree such as Associate and High School Degree in Management, Education, Administration, Health Care, Healthcare, Auditing, Business, Associates, Computer Science, Engineering

Skills for Provider Data Specialist

Desired skills for provider data specialist include:

Business strategies
Medical terminology
Standard PC packages
Cactus claims system
Medicaid / Medicare / Commercial rules and regulations
Microsoft Excel

Desired experience for provider data specialist includes:

Must have an understanding of Medicare and Medicaid
Building and maintaining automation databases that are designed to detect and identify defects in provider data
Conducts audits in-process manual and semi-automated inspections for specific transactions utilizing data mining and intelligence tools
Conducts audits in-process manual and automated inspections for specific transactions utilizing data mining and intelligence tools
Review, analyze and report on Service Tracker data for trends, gaps and variances
Reviews and resolves entries in project spreadsheets without managerial approval required for each resolution

Provider Data Specialist Examples


Provider Data Specialist Job Description

Job Description Example
Our innovative and growing company is looking for a provider data specialist. Please review the list of responsibilities and qualifications. While this is our ideal list, we will consider candidates that do not necessarily have all of the qualifications, but have sufficient experience and talent.
Responsibilities for provider data specialist
  • Oversees the QC process, including review of project spreadsheets, the providing of feedback to staff, and communicating with programming team staff regarding required corrections
  • Plays a significant role in both phone and abstraction trainings
  • Serves as data collection team liaison with programming team and points of contact with respect to the electronic transfer of Authorization Forms
  • Identify and validate sources of required data
  • Define source-specific requirements to close gaps in instrumentation and/or data collection
  • Collaborate with source system and reporting resources to develop and implement reporting solutions and enhancements
  • Establish reporting process, streamline reporting activities, and publish regular reporting schedule
  • Gather necessary data and interpret results
  • Work closely with matrix partners to gather and interpret data related to their specific areas
  • Provides detailed data research and analysis of results to improve efficiency and metrics
Qualifications for provider data specialist
  • Experience working on MEPS project
  • Communication and interpersonal skills required to guide, moderate and exchange information across all levels of the division and project organization
  • Ability to adapt to and implement changes in workload, workflow, and project assignment specifications
  • Skills in time management, personal organization, and setting priorities to meet project requirements
  • Create and maintain multiple databases, including, contract provider network, prior authorization, third party liability, provider set ups and related corrections
  • Oversee the provider termination process including adding and changing new or existing provider records in the medical information system

Provider Data Specialist Job Description

Job Description Example
Our growing company is looking to fill the role of provider data specialist. If you are looking for an exciting place to work, please take a look at the list of qualifications below.
Responsibilities for provider data specialist
  • This position is to support provider contracting within PCDM Regional Contract Loading Team
  • Responsible for maintaining current, accurate information in all provider database environments by conducting periodic provider data update surveys and processing demographic change requests received from internal and externa sources
  • Prepares as necessary all provider demographic data in the format required by the CI/ACO Help Desk Team for entry into the Physician Relationship Management Tool
  • Runs regular reports on provider data to ensure ongoing accuracy, and reconciles and corrects discrepancies as necessary
  • Publishes monthly (and otherwise as needed) provider directories for internal and external use
  • Supports regular communication about demographic and contract status changes (add/delete reports) with internal and external stakeholders, including payors
  • Communicates with all payors to maintain contract status and effective dates for all providers, and mediates for providers in credentialing/contracting process with payors
  • Conducts periodic network adequacy assessments
  • Provides departmental telephone support, serving as the initial point of contact for provider calls directed to ACN
  • Contributes to the preparation of monthly Network Development Committee meeting agendas and application files, including researching various public databases (OIG, BOMEX)
Qualifications for provider data specialist
  • Schedule monthly provider verifications regarding provider enrollment specifications and demographic changes
  • Update delegated provider Medicare and Medicaid documents on a monthly and ad hoc basis and ensure state compliance
  • Provide appropriate reports and statistical data to other department designees for review, follow-up and resolution
  • Perform general administrative tasks in support of assigned department
  • Knowledgeable in technology, especially databases and reporting
  • Position requires intermediate/advanced skills in MS Access and SAS

Provider Data Specialist Job Description

Job Description Example
Our innovative and growing company is looking for a provider data specialist. To join our growing team, please review the list of responsibilities and qualifications.
Responsibilities for provider data specialist
  • Acts as internal provider representative sending out information as needed to practices, to include preparing materials (packets, demographic reports, ) for use in provider visits
  • Develops, maintains and transmits fee schedules as necessary to TPAs and other appropriate stakeholders
  • Receives, researches, and processes provider/location requests related to additions, changes and terminations and ensures all requests are logged in appropriate database for performance measurement
  • Evaluates, researches, and resolves complex provider data maintenance requests and issues
  • Assist management with database / data integrity issue research and recommends resolutions
  • Identifies opportunities to improve processes to ensure efficient turnaround of issues and meets and exceeds established deadlines and performance standards
  • Responds to telephone calls, emails, and written requests from providers/locations internal departments related to provider/location set up in system
  • Ensure efficient, accurate and timely responses to provider requests related to participation in the panel
  • Distribute provider/location contracts and follow up to ensure all appropriate contracts are executed prior to provider/location participation on a panel
  • Assists in ensuring all appropriate documentation is maintained in document management application
Qualifications for provider data specialist
  • Must be knowledgeable about microcomputer systems, report writer, and query languages
  • Ability to multi-task, shifting effectively among multiple activities
  • Excellent organizational skills including ability to perform in a highly matrixed environment
  • Proven ability to listen, understand and interpret information from others
  • Customer Service/Data Loading experience
  • Prior NDB experience preferred

Provider Data Specialist Job Description

Job Description Example
Our innovative and growing company is hiring for a provider data specialist. Please review the list of responsibilities and qualifications. While this is our ideal list, we will consider candidates that do not necessarily have all of the qualifications, but have sufficient experience and talent.
Responsibilities for provider data specialist
  • Implement / participate in other Provider Relations team projects as requested
  • Coordinate product integration efforts between Strategy, Content, Engineering, and Providers
  • Develop expertise around Provider products and support client, provider, and internal product questions
  • Prioritize and coordinate product updates/changes and foster feedback dialog with the Providers and engineering
  • Set and track timeliness and quality objectives for data delivery and proactively follow up to address issues
  • Collaborate with Data Exchange Engineering to create and refine Provider facing integration tools
  • Verify with multiple primary sources organizations (i.e., New York State DOE, NPDB, ABMS, OIG, ) provider‘s status during initial credentialing and recredentialing cycles
  • Participate in ongoing sanctions monitoring process for contracted providers in the organization (i.e., FEHBP, OIG, OPMC)
  • Communicate with providers to obtain requisite information to facilitate timely processing and follow up on inquiries from providers, internal departments or payers related to the credentialing processes/data
  • Coordinate credentialing related data/profiles with various sources (i.e., Internal departments, provider groups, ) to support credentialing delegated arrangements
Qualifications for provider data specialist
  • Minimum 3 years experience in the healthcare industry with a focus on managed care or Government network administration, provider network administration, provider reimbursement methodologies, or claims administration
  • Bachelor’s degree in a health related, business information systems or other related field
  • 5 or more years of relevant experience may be considered in lieu of a degree
  • Prior experience with organizational skills, ability to prioritize and meet deadlines from multi-staff members within the department
  • Required to have a dedicated work area established that is separated from other living areas.Required to have a work area in a section of the residence that provides information privacy
  • Required to keep all Company sensitive documents secure

Provider Data Specialist Job Description

Job Description Example
Our company is hiring for a provider data specialist. Thank you in advance for taking a look at the list of responsibilities and qualifications. We look forward to reviewing your resume.
Responsibilities for provider data specialist
  • Conduct analysis on data integrity across the department’s multiple processes such as Credentialing and Provider Data Management activity
  • Participate in department activity for any payer initiatives related to provider data veracity and exchange
  • Participate in project implementation of major changes to the department’s processes
  • Participate in ongoing department process improvement initiatives
  • Perform Quality audits on completed provider data tickets to validate the work was completed accurately
  • Ensure audits are conducted in accordance with department standards
  • Utilize policy and procedure documents to complete audit activities
  • Identify opportunities for policy revisions based on common failures
  • Assist in determining root cause analysis and impact analysis throughout the data life cycle
  • Create and maintain a calendar of quality activities
Qualifications for provider data specialist
  • Minimum Bachelor’s degree or HS Diploma and 4 years of related experience
  • Required to have lockable drawers for the securing of confidential information
  • Associates degree in business, health care administration or similar field or an equivalent combination of education and experience
  • 2 years of healthcare experience in claims, medical staff office or similar field
  • Proficient in conducting internet searches and downloading information
  • 1-2 years of experience in customer service and/or data analysis experience

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