Data Integrity Specialist

Socket.dev; Oregon (WI); On-site; USD 52,000 - 76,000; Full time

Job summary

AllCare Health is seeking a Data Integrity Specialist for the Provider Services department in Grants Pass, Oregon. The role focuses on validating provider data across portal, directory, DSN, and reporting systems, supporting DSN, VBP and network adequacy inputs, and ensuring accurate data intake and validation for health care providers and facilities.

Qualifications include high school diploma or GED, 1–2 years in healthcare/insurance, NAMSS CPCS/CPMSM certification (or pursuing), and strong

Qualifications

• High school diploma or GED required.
• One to two years related experience in Healthcare or Insurance.
• NAMSS CPCS and CPMSM certification or actively pursuing it is preferred.
• Bilingual abilities (ASL or other languages) are valued.

Responsibilities

• Validate provider data in portal, directory, DSN, and reporting systems.
• Assist in QA, reconciliation, and data integrity across systems.
• Own front-end provider data intake and validation for providers and facilities.
• Coordinate with Provider Engagement, Credentialing, Contracting and other departments.

Skills

Bilingual

Attention to detail

Data analysis

Time management

Education

High school diploma or GED

Tools

Microsoft Office

Relias LMS

Job description

Data Integrity Specialist at AllCare Health with the Provider Services department in Grants Pass, Oregon

We Are Seeking Qualified Candidates to Join Our Team!

AllCare Health offers competitive wages, an excellent benefits package including affordable healthcare, 401k retirement, wellness programs, and flexible schedule options.

Summary of the Position

This position is responsible for validating provider data reflected in the provider portal, directory, DSN, network adequacy, VBP and other reporting. Assists in quality checks and reconciliation of the data across systems to ensure accuracy of reporting across the organization. Ensures the efficient and timely completion of front-end provider data intake and validation for all health care providers and facilities.

Essential Duties

1. Validates required elements for portal, directory, credentialing and EzCap configuration
2. Supports DSN, VBP, and network adequacy input and reporting
3. Maintains a high quality, timely and accurate credentialing in-take process for medical healthcare providers
4. Owns initial intake (applications, rosters, forms, demographic changes, network adequacy)

Job Duties

• Quality Assurance and Reconciliation
• Maintains up-to-date knowledge of NCQA, URAC, and JACHO credentialing standards.
• Works collaboratively and coordinates with Provider Engagement, Provider Setup, Credentialing, Contracting and other departments
• Respectfully takes direction from leadership
• Ensures complete and accurate documentation before data moves to setup
• Maintains punctual, regular and predictable attendance.
• Meets all required training including those listed in Relias Learning Module System (LMS).
• Performs other duties as assigned

On Call Responsibilities

This position does not have any on call responsibilities.

Supervisory Responsibilities

This position does not have any supervisory responsibilities.

Qualifications

Ability to perform essential job duties with or without reasonable accommodation and without posing a direct threat to safety or health of employee or others. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential duties.

Being bilingual in another language, including American Sign Language (ASL), is an invaluable skill that enhances our ability to deliver culturally responsive care. We strongly encourage you to apply if you are bilingual.

All relevant experience can be listed in your resume to perform essential duties of the position including the following: lived, volunteer, professional, or a combination of experience and education.

Education

High school diploma or general education degree (GED).

Experience

One to two years related experience and/or training inHealthcare or Insurance industries

Certificates, Licenses, and/or Registrations

Certification from NAMSS in CPCS and CPMSM or actively pursuing the certification.

Technical Skills

• Familiarity with the Healthcare industry.
• Excellent organization and time-management skills.
• Excellent computer skills, including the Microsoft Office Suite (Outlook, Word, PowerPoint, and Excel).
• Knowledge of and compliance with HIPAA regulations.
• Knowledge of operating systems, programming languages, software programs, networks and other technologies.
• Excellent at identifying and implementing improvement activities and ensuring excellence.
• Excellent at interpreting data and using it to solve problems and gain new insights.
• Excellent at locating information and synthesizing information from various sources.

Interpersonal Skills

• Demonstrate accountability, inspiring trust and confidence from others.
• Self-resolve most conflicts or misunderstandings with minimal need for direct supervision.
• Work with high initiative, energy and effectiveness in a fast-past environment.
• Effectively and professionally communicate with team members and customers.
• Collaborate within a multidisciplinary, diverse team to provide professional service.
• Prioritize and organize work according to competing timelines.
• Allocate your time so that you can complete tasks within established deadlines.
• Adapt to change, learn quickly, and work with ambiguity.
• Use creativity and resourcefulness to solve new problems.
• Cope and self-manage during stressful situations.
• Meet timelines for goals with high level of quality.

Language Skills

Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public.

Mathematical Skills

Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.

Computer Skills

Job requires specialized computer skills. Must be adept at using various applications including database, spreadsheet, report writing, project management, graphics, word processing, presentation creation/editing, communicate by e-mail and use scheduling software.

Reasoning Ability

Ability to solve practical problems and work with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.

Physical Demands & Work Environment

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

The employee must occasionally lift and/or move up to 10 pounds. While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel and talk or hear. The employee is occasionally required to stand; walk and reach with hands and arms. The noise level in the work environment is usually moderate.

• The employee must be able to work onsite, as needed.
• The employee must be able to work from a home office, as needed.

Company Overview

AllCare Health Website: https://www.allcarehealth.com.

AllCare Health is incorporated as an Oregon Benefit Corporation and has earned the coveted Certified B Corp status since 2017. As such, AllCare Health considers its impact on community, society, and the environment in all business decisions. We have long recognized the value in social, economic, and environmental concerns of our employees, customers, and community members. (Learn more about B Corps at https://bcorporation.net/about-b-corps)

AllCare Health headquarters are located in Grants Pass in Southern Oregon on the Rogue River, surrounded by mountains, forests, small farms, and breathtaking views. This thriving and energetic community is ideal for families and outdoor enthusiasts, with a temperate Pacific Northwest climate. We enjoy easy access to outdoor sports and recreation, river rafting, fishing, hiking, biking, wineries, outdoor concerts, the world-famous Ashland Shakespeare Festival, the stunning Oregon coast, magnificent redwood forests, pristine beaches, and much more.

The AllCare Health family of businesses is guided by our corporate principles:

Purpose

Working together with our communities to improve the health and well-being of everyone.

Values

Trust, Innovation, Relationships, and Voice.

Vision

Thriving, Inclusive, and Equitable communities.

Brand Promise

Changing Healthcare to Work for You.

AllCare Health is dedicated to building a diverse and authentic workplace centered in belonging and serving our growing community. If you are excited about this open position but your experience does not align perfectly with every qualification in this post, we encourage you to apply anyway or reach out to our human resources department. You may just be the right candidate for this role or others.

If you need accommodations, help in the application process, or wish to receive this job announcement in an alternative format, please call 541-471-4106 and ask for Human Resources.

All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sexual orientation, gender identity, sex, age, protected veteran or disabled status, or genetic information.

Monday - Friday; 8:00am - 5:00pm w/ a 1 hour unpaid lunch & two 15 minute paid breaks

40 hours per week