Provider Data Specialist

Work at Home
Immediate

Job Description

Grow with a company that is passionate about helping you maximize your full potential. Become a part of transforming customer and client experience through the utilization of our innovative work from home technology. At BroadPath we believe in assuming the highest intention for others, our employees are empowered through their voices which helps us to continue shaping the emerging future, bringing innovation, and flexibility to the Work from Home Industry. Provider Data Specialists provide file maintenance of the provider database, and ensures accuracy of high-volume data and maintenance of provider demographic and contract files. Additional responsibilities will include interpreting provider contractual language and guidelines and maintaining proper record keeping of all system support files.

Responsibilities

  • Maintain current and validated provider demographics, networks, tax identification, 1099 data, Medicare certification and NPI data in the system with a high level of accuracy and meeting minimum productivity requirements
  • Provide information to appropriate personnel in regard to changes and updates in system support files
  • Assist in education of providers, hospitals and the internal and external staff on demographic and network data requirements
  • Identify, assist, and resolve managed care issues concerning claims, contract interpretation, eligibility and general provider demographic operational issues
  • May communicate with network providers and staff and inform them of any operational, procedural, and contractual changes and updates
  • Assist internal departments in resolving provider and member appeals pertaining to the physician, ancillary providers and hospital network arrangements and plan contracts
  • Maintain accurate and current provider information and provides system support in provider network development
  • Assist with reporting network development needs in various geographic regions. Completes managed care contracts updates in the Impact system for payors and providers. Creates and processes required provider statistics and reporting

Basic Qualifications

  • Strong knowledge and understanding of healthcare planning as normally demonstrated through a minimum of one year of provider network planning and/or process management or operations experience
  • Requires strong Excel knowledge, ability to analyze statistical data, and the ability to work on a variety of projects in an organized fashion. Must possess a strong knowledge of business and/or healthcare as normally obtained through provider relations experience or healthcare provider file maintenance experience
  • Must have an understanding of managed care reimbursement strategies and methodologies for physicians, hospitals and ancillary providers. Must be able to communicate effectively with others by speaking, reading, and writing
  • McKesson/Portico/Change Healthcare Software experience required 

Preferred Qualifications

  • Bachelor’s degree in business, healthcare administration, or related field
  • One year of medical claims auditing and or provider data demographic processing experience and an understanding of medical terminology and knowledge of CPT-4 and ICD-9 coding
  • Additional related education and/or experience preferred

Our Network Data Specialist will receive the following benefits: 
  • Access to BroadPath's Limited Medical Plan starting first of the month after 60 days of employment. After one (1) year of full-time employment, you will receive access to our Major Medical Plan and 401k
  • Bhive kit; includes web camera which allows you to join our Connected Culture!
  • Employee Referral Bonus Program (Uncapped)
  • Weekly Pay