Position: Provider Data Maintenance Specialist

Location: Can be located in the following areas- Chicago, IL/Tulsa, OK/Albuquerque, NM/Helena, MT (Hybrid)

Employment Type: Full-Time Contract

Pay: $21 per hour

Responsibilities:

Analyze, research, and apply business rules to complete requests received from providers regarding adds/deletes/changes to their information used for claims processing, membership assignment, and directory purposes.
Contract, credential and maintain Facility / Professional provider data to support marketing and network contracting across all lines of business
Support the implementation of special projects, assisting with tracking of various phases of a project and managing workflow
Assist management in familiarizing and training team members with the various business rules in network contracting and credentialing across all lines of business
Identify gaps in processes and suggest process improvement strategies

Requirements:

HS Diploma/GED plus 1 year of experience with Provider Network contracting and credentialing systems OR 5 years of experience in the Health Care industry
Written and verbal communication skills including interpersonal skills
Skills to develop training materials and act as an advisor to staff
Experience and proficiency in Microsoft Office software products including analytical tools
Experience developing reports

Preferred:

Bachelor’s degree
Subject Matter Expert for the Professional Provider Credentialing Process
2 years of experience with current government sponsored health insurance networks
Knowledge of health care delivery systems, claim costing analytics, and provider network adequacy analytics