America's Job ExchangeAJE

Maintains current provider data for the largest, most complex account structures. Maintains provider data to ensure the quality of the network. Coordinates provider enrollment, and assists with coordination of meetings with providers for training, contracting, and reporting. May be responsible for reporting and tracking provider calls and complaints. Updates directories for all contracted organizations. May be responsible for reporting and tracking provider calls and complaints..Responsible for batching and reviewing items for loading in Provider Data Management. Conducts outreach for our vendor to assure accuracy in CPF/PWB. This position is the liaison between our vendor and matrix partners.



Under General Supervision, logs incoming Provider Data Requests in system, requests necessary information, and makes provider outreach calls to obtain missing information.



Batch all incoming provider data requests in ETQS within assigned timeframes and according to established protocols.



Reviews incoming work to find information that may be missing and outreaches to provider to obtain the missing information.



Conducts additional outreach at request of Data Analysts to obtain all missing information necessary to complete the PDM transaction or pended claim transaction.



Identifies opportunities to automate as work is batched and completes requests.



Supports vendor as directed by Manager.



Identifies opportunities for improvement in processes and workflows as well as volume reduction opportunities..Strong working knowledge of managed care data systems and applications for claim payments.

Excellent oral and written communication skills.

Ability to work independently while managing multiple tasks and meeting deadlines.

Proven ability to maintain positive working relationships and to provide coaching and guidance to other staff members.

Technical sophistication and relational database concept and applications experience.

Strong computer background including proficiency with Windows software including Microsoft Word and Excel.

Ability to prioritize and manage multiple tasks.

Strong time management skills.

Strong investigative and decision-making skills.

High school graduate degree or equivalent required.

Two to three years' experience managed care experience preferred.

Proven skills in data management accuracy..

Job Benefits