Provider Data Specialist I

Jobtailor; Deutschland; Remote; EUR 36.000 - 48.000; Vollzeit

Zusammenfassung

Jobtailor is seeking a data specialist to support provider data within the QNXT module and ensure accurate data entry and governance.

You will add, maintain, and update provider records, assist with database integrity, and collaborate with medical offices and internal teams on enrollment and contracts. Strong Excel skills and familiarity with QNXT/Facets are essential for success.

Qualifikationen

• Minimum 1 year of experience with data configuration or claims management.
• Familiarity with relational databases.
• General understanding of or ability to learn managed care and Oregon Health Plan concepts.
• Familiarity with Microsoft Office Suite products, especially Excel.
• Ability to learn and effectively navigate claims processing technologies such as QNXT and Facets.
• Ability to learn and effectively navigate document management and collaboration platforms such as SharePoint and Office 365.
• Ability to follow policies and procedures.
• Ability to troubleshoot data integrity issues and identify root causes.
• Ability to author and maintain process documentation.
• Proficient listening, verbal, written, and customer service communication skills.
• Ability to articulate instructions and communicate effectively with non-technical staff.

Aufgaben

• Provide product data support for the QNXT module.
• Add, maintain, and update provider data records.
• Assist with database integrity and configure provider data and contract information.
• Perform accurate data entry following Provider Data policies and procedures.
• Provide data management and process knowledge and assist with projects.
• Investigate and resolve provider and provider contract pending claims.
• Monitor call and email queues and communicate with contracted provider offices and internal customers.
• Research demographic and affiliation changes and update the provider database after validation.
• Manage monthly provider rosters from contracted hospital systems and IPAs.
• Complete provider database projects resulting from contracting, configuration, or regulatory changes.
• Sort incoming faxes and PIVs and distribute them according to assignments.
• Maintain SharePoint libraries.
• Enroll providers with MMIS Web Enrollment Portal.
• Reroute critical return mail, including 1099s, live checks, and remittance advice.
• Troubleshoot provider portal issues.
• Troubleshoot provider setup supporting reporting, directories, and claims operations.
• Test new software versions.
• Validate data through license boards, IRS, NPPES, and other third-party verification.
• Resolve data errors through troubleshooter processes and internal audits.

Kenntnisse

Data Configuration

Data Management

Credentialing

Claims Management

Database Integrity

Data Entry

Process Documentation

Troubleshooting

Analytical Skills

Research Skills

Tools

QNXT

Facets

SharePoint

Office 365

MMIS Web Enrollment Portal

Jobbeschreibung

• Provide product support for provider data within the QNXT module
• Add, maintain, and update provider data records
• Assist with database integrity and configure provider data and contract information using written guidelines
• Perform accurate and timely data entry following Provider Data policies and procedures
• Provide data management and process knowledge and assist with projects
• Investigate and resolve provider and provider contract pending claims
• Monitor call and email queues and communicate with contracted provider offices and internal customers
• Research demographic and affiliation changes and update the provider database after validation
• Manage monthly provider rosters from contracted hospital systems and IPAs
• Complete provider database projects resulting from contracting, configuration, or regulatory changes
• Sort incoming faxes and PIVs and distribute them according to assignments
• Maintain SharePoint libraries
• Enroll providers with OHA Health Systems using the MMIS web enrollment portal
• Reroute critical return mail, including 1099s, live checks, and remittance advice
• Troubleshoot provider portal issues
• Troubleshoot provider setup supporting reporting, directories, and claims operations
• Test new software versions
• Validate data through license boards, IRS, NPPES, and other third-party verification
• Resolve data errors through troubleshooter processes and internal audits

Requirements

• Minimum 1 year of experience with data configuration, data management, credentialing, or claims management
• Familiarity with relational databases
• General understanding of or ability to learn managed care and Oregon Health Plan concepts
• Familiarity with Microsoft Office Suite products, especially Excel
• Ability to learn and effectively navigate claims processing technologies such as QNXT and Facets
• Ability to learn and effectively navigate document management and collaboration platforms such as SharePoint and Office 365
• Ability to follow policies and procedures
• Ability to troubleshoot data integrity issues and identify root causes
• Ability to author and maintain process documentation
• Proficient listening, verbal, written, and customer service communication skills
• Ability to articulate instructions and communicate effectively with non-technical staff
• Ability to handle multiple priorities and requests
• Attention to detail and deadlines
• Ability to develop analytical and research skills
• Ability to work effectively with diverse individuals and groups
• Ability to see, read, and perform repetitive finger and wrist movement for at least 6 hours/day
• Ability to hear and speak clearly for at least 3–6 hours/day

Core Competencies

Demonstrates expertise in data management and configuration, with a strong focus on provider data integrity and compliance with policies and procedures. Proficient in utilizing relational databases and collaboration tools to support claims processing and provider enrollment.

Highest-signal resume keywords

• Data Management
• Provider Data Configuration
• Claims Management
• Relational Database Familiarity
• Microsoft Office Suite Proficiency

Hard Skills

• Data Configuration
• Data Management
• Credentialing
• Claims Management
• Database Integrity
• Data Entry
• Process Documentation
• Troubleshooting
• Analytical Skills
• Research Skills

Soft Skills

• Customer Service Communication
• Attention to Detail
• Ability to Handle Multiple Priorities
• Effective Communication
• Listening Skills

Industry Keywords

• Managed Care
• Oregon Health Plan
• Provider Data Policies
• Regulatory Changes
• Provider Enrollment

Tools & Technologies

• QNXT
• Facets
• SharePoint
• Office 365
• MMIS Web Enrollment Portal