The Provider Data Management Specialist 2 will perform the end-to-end processes necessary to ensure the demographic data required to maintain and operationalize external provider contracts is accurately captured in source systems. This position is accountable for collection, analysis, validation, and set up of contract data elements, provider information, and practitioner demographics to support contracting, claims payment, credentialing, referrals, regulatory and network adequacy reporting, and directory display. The professional in this position will perform outreach needed to ensure all contracted provider data is accurately maintained within the defined business rules, data quality standards and regulatory timelines.
Major Responsibilities:
- Collect, analyze, validate, and establish contract data elements, provider information, and practitioner demographics to support contracting, claims processing, credentialing, referrals, regulatory compliance, network adequacy reporting, and directory accuracy.
- Maintain comprehensive provider demographic and contract data for all external contracted entities, including complex health systems and large medical group practices.
- Conduct proactive outreach to ensure all contracted provider data complies with established business rules, data quality standards, and regulatory timelines.
- Engage with contracted providers to facilitate timely and accurate updates of provider data, including practitioner roster modifications, terminations, practice location changes, updated W9 forms, pay-to locations, and ownership changes.
- Receive, document, and respond promptly to provider inquiries, calls, and emails pertaining to provider data and practitioner demographics.
- Validate provider-submitted data through verification platforms to ensure adherence to data integrity requirements.
- Utilize analytical and problem-solving skills to investigate and resolve data discrepancies and issues within required timeframes.
- Interpret, organize, record, and input contracted data, provider information, and practitioner demographics into source systems according to defined business rules and data architecture.
- Research and resolves claims issues related to external contracted provider demographics.
- Lead and participate in data reconciliation and remediation projects to maintain the integrity of contracted provider and practitioner demographic data.
Minimum Education and Work Experience:
- Associate degree or two (2) years healthcare experience.
- Proficiency with Microsoft Office Suite (e.g., Excel and Word) and Microsoft Power BI.
- Must possess strong analytical and problem-solving skills.
- Demonstrated proficiency and hands-on experience with database systems and data quality management.
- Ability to prioritize and manage multiple tasks and competing priorities.
- Knowledge of relevant laws, regulatory and accreditation requirements and standards (e.g., CMS, NCQA, Oregon and Washington state, network adequacy).
- Bachelor’s degree in business, healthcare or related field preferred.
- A minimum of five (5) years of experience in data management and analysis is preferred.
For more information about this position, contact Marisa Walter, marisa.e.walter@kp.org.
About Northwest Permanente:
We are the Permanente in Kaiser Permanente. Northwest Permanente is a self-governed, multi-specialty group of 1,500 physicians, clinicians, and administrative professionals caring for 630,000 members in Oregon and Southwest Washington. Together with Kaiser Foundation Health Plans and Kaiser Foundation Hospitals, we form Kaiser Permanente of the Northwest, an integrated health care program. Kaiser Permanente is one of the nation's preeminent health care systems, a benchmark for comprehensive, integrated, value-based, and high-quality care.
Our Northwest Permanente administrative professionals enjoy a wide range of company sponsored benefits:
- 15% employer contribution to retirement programs, including pension
- 90% employer-paid health plan
- Tuition Reimbursement
- Child Care Benefits
- Flexible Work Schedules
- Paid Parental Leave
- Self-Care Days + Paid Time Off
Equal Opportunity Employer
Northwest Permanente is an equal opportunity employer committed to fair, respectful, and inclusive workplaces. Applicants will be considered for employment without regard to race, religion, sex, age, national origin, disability, veteran status, or any other protected characteristic or status.
