Data Specialist

Duties:

Updating the system to make corrections on provider data. Will be using QNXT.

Job Description:

Responsible for the timely and accurate entry of provider demographic, contract affiliation, and fee schedule information into the health plan system. Must be able to accurately interpret request and configure provider data in such a way that ensures accuracy and claims adjudication is optimized.

Key Responsibilities:

·Receives information from outside parties for update of information in computer system(s). Analyses by applying knowledge and experience to ensure appropriate information has been provided.

·Maintains department TAT standard for loading of provider demographic data with affiliation and fee schedule attachment.

·Maintains department quality standard for loading of provider demographic data with affiliation and fee schedule attachment.

·Works on projects as assigned and within parameters given. Knowledge/Skills/Abilities: Computer literacy and proficient in Microsoft Excel and Word. Excellent organizational skills

·Ability to interact well with both internal and external customers.

·Excellent verbal and written communication skills Ability to abide by Client’s policies.

·Ability to maintain attendance to support required quality and quantity of work.

·Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA).

·Ability to establish and maintain positive and effective work relationships with co-workers, clients, members, providers and customers

Required Education:

High School Degree or equivalent GED

Required Experience:

0-2 years Managed Care experience in Claims, provider services, Provider Network Operations, hospital or physician billing, etc.

A minimum 1 year of data management experience, doesn't need to be healthcare related.

Must Haves: