POSITION SUMMARY

The Provider Data Specialist is responsible for various activities related to the Provider Network database, which may include any or all of the following: database maintenance, reporting and extracting data for various reports and analyses, and initiating database improvement. Provider Data Specialists maintain standards for database integrity and quality assurance, with Provider Data Supervisor coordinates corrective activities to clean database and communicates processes with Director regarding database improvements. Other responsibilities include participating in audits and providing feedback to reduce errors and improve processes and performance, maintaining current provider data to ensure the quality of the network and resolve claim issues related to provider data.

MAJOR RESPONSIBILITIES 

• Responsible for Provider Data Entry including data maintenance and verification
• Assist with database improvements and audits
• Responsbile for maintaining data integrity and quality assurance
• Solve moderately complex problems and/or conduct moderately complex issues in workgroup and consulting with provider relations and contracting teams for resolution as appropriate and escalating to supervisor as needed.
• Responsible for ensuring provider compliance with rules and regulations as dictated by legal, the Department of Defense, URAC, and departmental policies and procedures.
• Responsible for being compliant with rules and regulations in day to day activities in regards to or as dictated by legal, CHRISTUS Integrity, the Department of Defense, and URAC, NCQA, TDI, NM which can include, but is not limited to, interactions with providers and following and adhering to Departmental as well as Organizational policies and procedures.
• Respond as needed to internal and external customers regarding provider participation status.
• Collaborate with and maintain open communication with all departments within CHRISTUS Health to ensure effective and efficient workflow and facilitate completion of tasks/goals
• Follow the CHRISTUS Guidelines related to the Health Insurance Portability and Accountability Act (HIPAA), designed to prevent or detect unauthorized disclosure of Protected Health Information (PHI)
• Assist with departmental projects as needed.
• Other duties as assigned.