• Provider Data Management Specialist

    Region
    Portland Metro Area
    Full/Part Time
    Full Time
    Req ID
    4197
  • 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 Permanentente is seeking a Provider Data Management Specialist to perform the end-to-end processes necessary to ensure the contract and demographic data required to implement and operationalize external provider contracts is accurately captured in source systems. This position will be 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 position also performs outreach needed to ensure all contracted provider data is accurately maintained within the defined business rules, data quality standards and regulatory timelines.

    Responsibilities

    • Builds and maintains effective partnerships with contracted practitioners, provider groups, hospital and facility organizations to research and collect required data elements needed to implement provider contracts.
    • Captures and setup contract data, provider information and practitioner demographics into source 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 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.
    • Develop and maintains high level of data integrity and quality assurance standards.
    • Displays analytical and problem-solving skills to research and resolve data discrepancies and data integrity issues within required timeframe.
    • Collaborates between external provider representatives, and internal stakeholders including National Claims Administration, Quality Resource Management, Referral Center and Network Adequacy Program to respond to inquiries related to provider data.
    • Creates, researches, extracts and analyzes ad hoc reports to monitor data quality and support inquiries from business units and stakeholders.
    • Participates in data reconciliation and remediation projects necessary to ensure contracted provider data and practitioner demographic data integrity.
    • Assists in data integrity audits and provides feedback to reduce errors and improve processes and performance.
    • Supports a variety of priority contracting project responsibilities, as assigned by leadership. Examples include researching and evaluating potential providers available to meet care delivery requirements in market expansion areas.
    • Develop and maintain systematic workflows and policies & procedures that support accurate and timely provider data management.
    • Performs general administrative tasks to support contracting and provider data management needs.

    Qualifications

    • Associate degree or two (2) years directly related experience.
    • Three (3) years of experience with computer, PC entry, using Microsoft Office applications and 10 keys by touch.
    • Three (3) year of experience in a position requiring professional written and oral communication skills.

       Additional Requirements

    • Experience using MS Excel, MS Word, MS Access to organize and communicate information.
    • Experience problem solving and researching issues related to data integrity
    • Thorough knowledge and experience with multiple data collection techniques and data quality control.
    • Excellent written and verbal communication skills.
    • Attention to detail and excellent organizational skills.
    • Ability to prioritize and manage multiple tasks and competing priorities.
    • Strong customer service-oriented focus, must be able to demonstrate professional phone and written skills.
    • Knowledge of relevant laws, regulatory and accreditation requirements and standards.
    • Strong interpersonal skills, establishing rapport and working collaboratively with others.
    • Familiarity with managed care contracting.

     Preferred Work Experience and Qualifications

    • Four (4) years’ experience processing contracted provider data within a managed care organization with direct interaction with the provider.
    • High level of proficiency in Microsoft Office products and proficient in various software applications with strong aptitude to perform complex data configuration tasks.
    • Position requires a highly self-motivated person who can apply judgment in the prioritization of assignments.
    • Understanding of managed care contracting and data management reporting requirements.
    • Advanced knowledge of relevant laws, regulatory and accreditation requirements and standards.
    • Ability to synthesize a variety of data to produce a cohesive and well-documented process.
    • Ability to work with a diverse group of people both internally and externally, including physicians, management, and leadership; ability to develop strong interpersonal relationships and use tact, diplomacy, and influence as necessary to achieve desired outcomes.

    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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