• Lead, Provider Data Management Specialist

    Region
    Portland Metro Area
    Full/Part Time
    Full Time
    Req ID
    4196
  • Overview

    Northwest Permanente, P.C. is a self-governed, physician led, multi-specialty group of over 1500 physicians, surgeons, and clinicians, caring for over 600,000 members in Oregon and Southwest Washington.  Northwest Permanente is seeking a Provider Data Management Specialist Lead to act in a lead capacity for the provider data management daily activities that support contracting, claims payment, credentialing, referrals, regulatory and network adequacy reporting, and directory display. The position will collaborate with internal staff to ensure the timely and accurate configuration of contract data, provider information, and practitioner demographics in source systems within contract specifications, business rules and system architecture.

    This position will help define data collection methodologies, processes, business rules, policies, reporting tools and metrics to ensure accuracy of provider data and identify opportunities to increase productivity and efficiency.

    In addition, the position will function as a liaison between providers, contract managers, systems teams, and credentialing staff as well as other related departments to ensure data integrity, error resolution, and process improvement.

    Responsibilities

    Leads and is accountable for daily end-to-end provider data collection, setup, and maintenance to ensure accurate and timely data needed to support functional areas including contracting, claims payment, credentialing, referrals, regulatory and network adequacy reporting, and directory display.

     

    Duties:

    • Builds and maintains effective partnerships with contracted practitioners, provider groups, hospitals and facility organizations in order to research and collect required data elements needed to implement provider contracts.
    • Captures and setup contract data, provider information and practitioner demographics into sources systems within defined business rules and data architecture.
    • Performs contract and data analysis to ensure provider data is correctly configured into systems.
    • Validates data elements submitted by provider on verification websites to meet data integrity standards.
    • Works closely with Quality Resource Management Department’s team to initiate credentialing and organizational assessments.
    • Proactively reaches out and engages contracted providers to ensure timely receipt and accurate processing of provider data updates including processing practitioner roster additions, terminations and practice location changes, updated W9s, pay to locations, ownership changes.
    • Receives, documents, and ensures timely response to provider inquires; phone calls, emails, related to provider data and practitioner demographics.
    • Applies knowledge of requirements from federal and state regulator including network adequacy and directory reporting, and directory
    • Maintains high level of data quality standards.
    • Performs intake triage and responds to provider data inquiries from internal departments and request for reporting.
    • Researches, investigates and resolves complex provider data management issues.
    • Conducts data integrity audits, monitoring and analysis in accordance with provider contracts, system configuration, and regulatory requirements.
    • Liaise with internal stakeholders and departments (e.g., systems, network adequacy, compliance) to ensure to data integrity and business needs are addressed
    • Manages special projects related to provider data remediation and data quality.  

    Qualifications

    • Associate degree or two (2) years directly related experience.
    • Five (5) years of experience with computer, PC entry, using Microsoft Office applications and 10 keys by touch.
    • Five (5) year of experience in a position requiring professional written and oral communication skills.

        Additional Requirements:

    • Demonstrated ability to organize and prioritize work.
    • Customer service experience preferably with healthcare operations.
    • Experience in a managed care, health plan administration, or medical office environment.
    • Ability to adapt to a fast-paced environment with shifting workloads.
    • Position requires a highly self-motivated person who is able to apply judgment in the prioritization of assignments.
    • Able to learn and retain new or evolving information and procedures.
    • Proficient in Microsoft Office products and experience in various computer applications.
    • Strong attention to detail.
    • Strong familiarity with managed care contracting principles and construct.
    • Ability to communicate effectively both orally and in writing.
    • Demonstrated ability to lead and work well with others and work in a team environment.
    • Knowledge of relevant laws, regulatory and accreditation requirements and standards.

    At Northwest Permanente, P.C., we are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants without regard to race, color, religion, sex, pregnancy (including childbirth, lactation and related medical conditions), national origin, age, physical and mental disability, marital status, sexual orientation, gender identity, gender expression, genetic information (including characteristics and testing), military and veteran status, and any other characteristic protected by applicable law. Northwest Permanente, P.C. believes that diversity, inclusion, and equity among our employees is critical to our success and we seek to recruit, develop and retain the most talented people from a diverse candidate pool.

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