Position Summary
Maintains the Provider Data (demographic and contractual) for all network and non-network providers.
-Will be part of the Comet Engine PDS Team
– Ensures all provider information is accurately recorded and maintained to provide for proper reimbursement and member access (i.e., directory listings).
– Develops and maintains standards for database integrity, corrective actions, database alignment, and manages communication processes with other departments regarding database improvements.
– Provides support for baseline provider data transactions that cannot be administered automatically through the provider database due to system limitations and/or data integrity issues.
– Performs baseline demographic transaction updates in provider system applications in support of claim adjudication and Provider directory.
– Provides on-going department support in research and analysis essential to resolving concerns/issues raised by providers and other internal/external customers.
Required Qualifications
– 1-3 years of Provider Data Services background.
– 1-3 years Network background.
– 1+ years QNXT experience.
– Microsoft Excel skills including knowledge of formulas.
– Demonstrated ability to handle multiple assignments.
–Problem solving and decision-making skills