Provider Data Lead Jobs

Job Number: 5725

Position Title: Provider Data Specialist-NE

External Description

Provider Data Lead

Position Summary

The Provider Data Lead will collaborate with team members on the entry of provider data based on defined business rules into the managed care system and perform review of provider data entry of all types to ensure proper expectations for downstream processes as directed by the Provider Data Management Manager/Director.

General Duties/Responsibilities

(May include but are not limited to)

• Work with Provider Data Manager/Director on creating and maintaining provider data business rules to support operational activities
• Perform review and analysis on inquiries receive and work to provide resolution for potential discrepancies identified by business stakeholder
• Collaborate with internal and external areas to understand business objectives and provide support for downstream workflows (e.g. provider directory, membership assignment, etc)
• Support operations from a provider data perspective in various capacities where there is impact including benefit/contract configuration, claim processing (e.g. Claims IQ), membership and eligibility panel requests, credentialing, and network support
• Monitor compliance of contracted medical groups’ adherence to CMS’ standards (e.g. valid NPI setup, compliance review, etc).
• Ability to define, explain, and escalate potential issues that are identified to Provider Data Manager/Director for review and resolution
• Collaborate with external vendors on improvements and business efficiency activities
• Provide support in the entry of provider demographic information into AHC’s provider database, as well as any updates necessary to existing provider’s demographic records
• Review, assign, and validate provider update requests in internal ticket management system in collaboration with Provider Data Manager/Director
• Test AHC’s provider database as necessary or during system enhancement periods and assist with any system integrations related to provider database
• Act as a subject matter expert for provider data activities

Supervisory Responsibilities

None

Minimum Requirements

• 2-3 years’ experience in provider services, healthcare services or IT as clerk
• No license, certification required
• Medical terminology, and Healthcare coding familiarity is a plus, but not required
• Education/Licensure:
• High School diploma or general education degree (GED)
• Minimum Experience:
• Basic computer skills required
• Analytical and problem solving is a plus
• Excellent organization and clerical skills
• Other
• Data entry minimum of 45 wpm
• Proficiency in Microsoft applications a must

Language Skills: Ability to read and interpret documents such as safety rules, operating and maintenance instructions and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of the organization.

Reasoning Skills: Ability to apply common sense understanding to carry out detailed but uninvolved written or oral instructions. Ability to deal with problems involving a few concrete variables in standardized situations.

Essential Physical Functions

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.
• While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.

FLSA Status: Non-Exempt

City: Remote-US

State: California

Location City: Remote-US

Location State: California

Community / Marketing Title: Provider Data Lead

Company Profile

Alignment Health was founded with a mission to revolutionize health care with a serving heart culture. Through its unique integrated care delivery models, deep physician partnerships and use of proprietary technologies, Alignment is committed to transforming health care one person at a time.

By becoming a part of the Alignment Health team, you will provide members with the quality of care they truly need and deserve. We believe that great work comes from people who are inspired to be their best. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment community.

EEO Employer Verbiage

Alignment requires all new hires to follow local and/or state requirements regarding the COVID-19 vaccine and booster. If applicable, proof of vaccination and booster will be required as a condition of employment subject to legal exemptions. This policy, which Alignment reserves the right to modify, is part of Alignment’s ongoing efforts to ensure the safety and well-being of its staff and community and to support public health efforts.

Alignment Healthcare, LLC is proud to practice Equal Employment Opportunity and Affirmative Action. We are looking for diversity in qualified candidates for employment: Minority/Female/Disable/Protected Veteran.

If you require any reasonable accommodation under the Americans with Disabilities Act (ADA) in completing the online application, interviewing, completing any pre-employment testing or otherwise participating in the employee selection process, please contact [email protected].

• DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health’s talent acquisition team, please email [email protected].