Provider Credentialing & Data Specialist II (Data Entry)
About the position Responsibilities • Retrieves applications and/or data from central repositories for provider data. • Accesses various external websites, internal matrices, and contacts organizations to verify accuracy of information provided. • Identifies whether application and/or document is clean or requires further review and routes to appropriate area. • Enters verified data into the Provider Data Management Systems. • Identifies eligibility for networks and updates appropriately affecting the accuracy of claim payments and the provider directory. • Electronically contacts providers and/or internal departments when data is incomplete. • Works with internal staff members, provider office staff, academic entities and/or other health related entities to verify the accuracy of the information provided. • Generates reports from system for prioritization of work queue. • Evaluates and researches practitioners that do not meet network participation criteria or are found to have on-going sanction monitoring issues. • Gathers and summarizes information for Credentialing Committee or Provider Contracting and responds to questions as needed. • Researches questions for accreditation or regulatory audits. • Supports special projects as needed. • Performs other duties as assigned. Requirements • Associate degree in business or healthcare administration or related field, or equivalent combination of education/training and experience. • 1 year of experience as a Provider Credentialing & Data Specialist or equivalent experience in a health plan, medical office, hospital, or similar administration. • Intermediate Microsoft Office (Word, Excel), database reporting, OnBase (document management system), and internet navigation skills. • Knowledge of provider credentialing and/or database management procedures. • Strong data entry skills. Nice-to-haves • CPCS certification preferred but not required. Benefits • Employee bonus program. • 401(k) with company match up to 4% and an additional company contribution. • Health Savings Account with a company matching contribution. • Excellent medical, dental, vision, life and disability insurance. • Access to an Employee Assistance Program, which includes professional counseling, personal and professional coaching, self-help resources and assistance with work/life benefits. • Company holidays and up to 16 PTO days during the first year of employment with options to carry over unused PTO time. • Parental leave for eligible employees who become parents through maternity, paternity or adoption after 120 days of service. • Career development programs and classes. • Mentoring and coaching to help you advance in your career. • Tuition reimbursement up to $5,250 per year.