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Provider Data Specialist

4 months ago

Phoenix, United States TriWest Healthcare Alliance Full time

**Profile**:

- Veterans, Reservists, Guardsmen and military family members are encouraged to applyWe offer remote work opportunities (AK, AR, AZ, CA, *CO, FL, *HI, IA, ID, IL, KS, LA, MD, MN, MO, MT, NE, NV, NM, NC, ND, OK, OR, SC, SD, TX, UT, VA/DC, *WA, WI & WY only)**Job Summary**

**Education & Experience**

**Required**:

- High School Diploma or GED
- 2 years of varied responsible experience with computer database programs

**Preferred**:

- 2 years of data entry experience
- Experience using Provider Data Management Systems

**Key Responsibilities**
- Process provider data inventory within expected timeline while meeting accuracy and production targets.
- Identify, research, and analyze issues received to determine appropriate handling. Resolve provider data correction requests in a specified time frame. Manage daily follow up of Provider data correction requests and resolve all issues to ensure databases are current and accurate.
- Maintain and process reimbursement terms to ensure correct claims payment and downstream processing.
- Review Provider contract language and identify when the contract is out of compliance. Process Provider contracts, run reports and respond to inquiries regarding contract compliance issues; image and index contracts and return images to network subcontractors. Conduct quality assurance activities to ensure image quality and completion of image activities.
- Support requests for assistance and research issues using various resources including online searches and phone calls.
- Communicate clearly through both written and verbal forms of communication and follow up with various parties to ensure tasks are completed within the allotted timeline or issues are escalated appropriately.
- Coordinate with internal departments for provider database related issues.
- Perform all other related duties as assigned by supervisor.
- Regular and reliable attendance is required.

**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.

**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**:

- Availability to cover any work shift
- Works within a standard office environment, with mínimal travel
- Extensive computer work with prolonged periods of sitting
- Works within a standard office environment, with mínimal travel
- Must be a U.S. Citizen
- Must be able to receive a favorable Interim and adjudicated final Department of Defense (DOD) background adjudication

**Company Overview**:
**Taking Care of Our Nation’s Heroes.**

**It’s Who We Are. It’s What We Do.**

Do you have a passion for serving those who served?

**Join the TriWest Healthcare Alliance Team We’re On a Mission to Serve®**

Our job is to make sure that America’s heroes get connected to health care in the community.

At TriWest Healthcare Alliance, we’ve proudly been on that important mission since 1996.

**DoD Statement**:
Our Department of Defense contract requires US citizenship and a favorably adjudicated DOD background investigation for this position.

**Benefits**:
We’re more than just a health care company. We’re passionate about serving others We believe in rewarding loyal, hard-working people who are willing to learn as they grow. TriWest Healthcare Alliance values teamwork. Join our team, fulfill your responsibilities, and you may also be considered for frequent pay raises, overtime opportunities to earn even more, recognition and reward programs, and much more. Of course, we also offer a comprehensive and progressive compensation and benefits package that includes:

- Medical, Dental and Vision Coverage
- Generous paid time off
- 401(k) Retirement Savings Plan (with matching)
- Short-term and long-term disability, basic life, and accidental death and dismemberment insurance
- Tuition reimbursement
- Paid volunteer time
- *Annual base salary for Colorado, Hawaii and Washington State residents: $33,000-$42,000 depending on experience***Equal Employment Opportunity**: