Senior Provider Data Specialist

1 month ago


Corvallis, Oregon, United States HexaQuEST Health, Inc. Full time
Job Title: Provider Data Specialist

Job Summary:
As a senior technical lead, you will be responsible for ensuring that provider data is entered and administered properly and in a timely manner. You will stay current on regulations and compliance issues, leading the advocacy of the PDM data entry process as it applies to cross-functional data support. You will meet regularly with other Provider Services departments to ensure proper workflow development and policies/procedures are maintained.

Department Overview:
Samaritan Health Plans (SHP) operates a portfolio of health plan products under several different legal structures. SHP is designated as a regional Coordinated Care Organization (CCO) for Medicaid beneficiaries, and Samaritan Health Plans, Inc. offers Medicare Advantage, Commercial Large Group, and Commercial Large Group PPO and EPO plans. SHP is also the third-party administrator for Samaritan Health Services' self-funded employee health benefit plan. As part of an Integrated Delivery System, Samaritan Health Plans is strategically and operationally aligned with Samaritan Health Services' mission of Building Healthier Communities Together.

Responsibilities:
Associate's degree or equivalent experience required. Two (2) years experience in Provider Services required. Two (2) years experience in Health Plan Insurance Plans required. Previous Facets, or similar provider data or claims processing system experience required. Previous claims experience preferred. Experience in documenting processes, creating workflows and policies required. Knowledge of compliance requirements and procedures preferred. Critical and analytical thinking skills required. Project implementation experience preferred. Experience in other provider related healthcare departments, such as credentialing, provider relations or contracting preferred.

Work Environment:
Normal shifts, no weekends. Not Needed for state license. Minimum 2 years of experience required. Minimum 40 guaranteed hours. Specialty Type: Clerical. Sub Specialty: Medical Staff Coordinator, Data Quality Specialist. Bilingual: No. EMR Used: No Listing. Holiday Coverage Required: No

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