Provider Data Specialist

Job Summary

Ensures accurate, timely maintenance and synchronization of critical provider data across all provider databases and systems. Accesses and utilizes multiple software applications. Applies business rules and knowledge of Provider contract language, pricing and reimbursement methodologies to each database / system to validate Provider information across systems. Communicates with internal and external clients by phone and email to clarify data and follow-up on issues, while working under timeline, accuracy, and production targets. Requires the ability to manage a large amount of complex information and must be able to communicate clearly and draw sound conclusions. Supports the maintenance of accurate, up-to-date provider data to include updates, changes, additions and terminations for assigned files.

Education & Experience

Required :

• High School Diploma or GED
• U.S. Citizenship
• Must be able to receive a favorable Interim and adjudicated final Department of Defense (DOD) background investigation
• One year experience in a customer service role or administrative support work requiring data entry work
• Proficiency in using Microsoft Office products and the Internet

Preferred :

Key Responsibilities

Competencies

Commitment to Task : Ability to conform to established policies and procedures; exhibit high motivation.

Communication / People Skills : Ability to influence or persuade others under positive or negative circumstances; adapt to unique styles; listen critically; collaborate.

Computer Literacy : Ability to function in a multi-system Microsoft environment using Word, Excel, Outlook, TriWest Intranet, the Internet, and department software applications.

Organizational Skills : Ability to multi-task, adjust to priorities and learn new systems, within the time constraints and with available resources; must be detail-oriented.

Problem Solving / Analysis : Ability to solve problems through systematic analysis of processes with sound judgment; has a realistic understanding of relevant issues.

Technical Skills : Proficient with key databases, including FoxPro, Claims Systems, Medical Management Systems, and Provider Data Management Systems; working knowledge of VA policies and procedures, current knowledge of claims, reimbursement methodology; healthcare or managed care experience.

Working Conditions

Working Conditions :