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Provider Data Specialist

1 month ago

Albany, New York, United States Versant Health Full time
Job Title: Provider Data Specialist

We are seeking a highly skilled Provider Data Specialist to join our team at Versant Health. As a key member of our organization, you will play a critical role in managing our provider networks and ensuring the accuracy of our provider data systems.

Key Responsibilities:
  • Manage and maintain accurate and up-to-date provider data in our systems, including demographic and payee information.
  • Perform additions, changes, and terminations to our provider data systems to ensure the accuracy of our Provider Directory, Utilization Management, and claims processing.
  • Conduct periodic audits, maintenance, and troubleshooting of provider, office, and payee data using the National Practitioner Identifier (NPI) Registry, state's Provider Master Files for Medicaid Registration, and Tax Identification programs.
  • Collaborate with internal and external customers to resolve issues and provide guidance on provider data management.
  • Manage complex Retailer and Provider Group data by periodically reviewing and updating our provider databases and rosters.
  • Support Versant Health's Accounts Receivable Department with provider education on Negative Balance accounts and network suspension and reactivations.
  • Educate and assist Providers and their office personnel with understanding the uses, importance, and impact of their provider data to Members and the Provider Directory.
  • Conduct peer review audits and provide feedback to reduce errors and improve processes and performance.
Requirements:
  • Four to Five (4-5) years of experience with a managed care organization in a Provider Data Management, Credentialing, Network Management, Network Development, and/or Provider Relations role.
  • Combination of education and work experience required; Associate or Bachelor's degree preferred.
  • Capable and comfortable dealing with Protected Health Information (PHI), Personal Identifiable Information (PII), sensitive, and confidential information with discretion and trust.
  • Experience must include direct responsibility for managing provider, office, and payee data and/or claims processing.
  • Experience working with provider networks and healthcare providers.
  • Knowledge and experience in CMS Provider Directory regulations.
  • Proficiency in Microsoft Office Excel, Word, Excel, Access, and Power Point.
What We Offer:
  • A comprehensive Total Rewards package, including health and dental insurance, tuition reimbursement, 401(k) with company match, pet insurance, and no-cost-to-you vision insurance for you and your qualified dependents.
  • Opportunities for advancement and development throughout all stages of your career with us.
  • A team environment with strong leadership and a commitment to your success.

Versant Health is an Equal Employment Opportunity and Affirmative Action employer dedicated to attracting, retaining, and developing a diverse and inclusive workforce. We are committed to providing a work environment that is free from discrimination and harassment. We are proud to be an Equal Opportunity Employer and welcome applications from diverse candidates.

The wage range for this position is [$20.00 to $22.50]. All incentives and benefits are subject to the applicable plan terms.