Provider Data Lead

Job Number: 6048

Workplace Type: Fully Remote

Position Title: Provider Data Specialist-NE

External Description:

Provider Data Lead

 

Position Summary:
The Provider Data Lead will collaborate with team members on the entry of provider data based on defined business rules into the managed care system and perform review of provider data entry of all types to ensure proper expectations for downstream processes as directed by the Provider Data Management Manager/Director. 

 

General Duties/Responsibilities:

(May include but are not limited to)

• Provide support in the entry of provider demographic information into AHC’s provider database, as well as any updates necessary to existing provider’s demographic records
• Work with Provider Data Manager/Director on creating and maintaining provider data business rules to support operational activities
• Collaborate with internal and external areas to understand business objectives and provide support for downstream workflows (e.g. provider directory, membership assignment, etc)
• Support operations from a provider data perspective in various capacities where there is impact including benefit/contract configuration, claim processing (e.g. Claims IQ), membership and eligibility panel requests, credentialing, and network support 
• Review, assign, and validate provider update requests in internal ticket management system in collaboration with Provider Data Manager/Director
• Act as a subject matter expert for provider data activities
• Perform review and analysis on inquiries receive and work to provide resolution for potential discrepancies identified by business stakeholder
• Ability to define, explain, and escalate potential issues that are identified to Provider Data Manager/Director for review and resolution
• Monitor compliance of contracted medical groups’ adherence to CMS’ standards (e.g. valid NPI setup, compliance review, etc).
• Test AHC’s provider database as necessary or during system enhancement periods and assist with any system integrations related to provider database
• Collaborate with external vendors on improvements and business efficiency activities

Supervisory Responsibilities:

None

 

Minimum Requirements:

1. Minimum Experience:
   1. 2-3 years’ experience in provider services, healthcare services or IT as clerk
2. Education/Licensure:
   1. High School diploma or general education degree (GED)
   2. No license, certification required
3. Other
   1. Basic computer skills required
   2. Proficiency in Microsoft applications a must
   3. Data entry minimum of 45 wpm
   4. Analytical and problem solving is a plus
   5. Medical terminology, and Healthcare coding familiarity is a plus, but not required
   6. Excellent organization and clerical skills

Language Skills:  Ability to read and interpret documents such as safety rules, operating and maintenance instructions and procedure manuals.  Ability to write routine reports and correspondence.  Ability to speak effectively before groups of customers or employees of the organization.

Reasoning Skills: Ability to apply common sense understanding to carry out detailed but uninvolved written or oral instructions.  Ability to deal with problems involving a few concrete variables in standardized situations.

Essential Physical Functions:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

 

1. While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.
2. The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.

FLSA Status: Non-Exempt

City: Remote-US

State: California

Location City: Remote-US

Location State: California

Community / Marketing Title: Provider Data Lead

Company Profile:

Alignment Health is revolutionizing health care for seniors by leveraging our world-class technology platform, innovative care delivery models, deep physician partnerships and our serving heart culture! From member experience professionals and clinicians, to data scientists and operations leaders, we have built a talented and passionate team that is deeply committed to our mission of transforming health care for the seniors we serve. Ready to join us?

At Alignment Alignment, delivering exceptional care to seniors starts with ensuring an exceptional experience for our over 1,300 employees. At the center of our employee experience is a culture where employees at all levels and across all teams are encouraged to share their unique ideas and perspectives. After all, when you can bring your authentic self to work, whether that’s in a clinical setting, our corporate office or a home office, creativity and innovation flourish! Another important part of the Alignment culture is a belief in continuous learning and growth. As a result, in this fast-growing company, you will find ample support to grow your skills and your career – with us.

EEO Employer Verbiage:

 Please note: All clinical positions are contingent upon successful engagement with Alignment Health’s COVID-19 Vaccination program (fully vaccinated with documented proof or approved exception/deferral).

Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.

*DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health’s talent acquisition team, please email [email protected].