Provider Data Integrity Specialist

PacificSource Health Plans; Missouri; On-site; USD 36,000 - 57,000; Full time

Job summary

PacificSource Health Plans is seeking a Provider Network Maintenance Associate to maintain provider data accuracy and support network operations. The role involves updating records, ensuring regulatory compliance, and collaborating with Provider Relations, Credentialing, and Contracting teams to ensure timely reimbursements.

The position requires at least 2 years in an office environment, data entry proficiency, and familiarity with provider networks.

Qualifications

• Two years of office experience required; healthcare data management preferred.
• Experience with provider networks, credentialing, contracting or reimbursement processes is a plus.
• Strong data entry accuracy and speed, attention to detail and ability to work with multiple systems.

Responsibilities

• Enter and update provider demographic, credentialing and contract information in PacificSource systems.
• Process provider additions, terminations and changes to maintain data integrity and accurate contract rows.
• Audit provider data for accuracy, regulatory compliance and ongoing data integrity.
• Assist in managing provider directories to keep them current and useful for members.
• Verify licensure, Medicare and Medicaid eligibility using approved tools to meet regulatory standards.
• Support monitoring of provider records to ensure compliance with policies and contracting regulations.
• Collaborate with internal teams to resolve data issues and respond to provider inquiries.
• Communicate with providers to obtain documentation and clarify discrepancies, maintaining professional relationships.
• Support other team members and contribute to data quality initiatives and process improvements.
• Assist in best-practice development for data entry and provider network projects.

Skills

Data entry

Written communication

Typing

Medical terminology

Education

High School Diploma

Associate/Bachelor’s degree preferred

Job description

PacificSource Health Plans is seeking a Provider Network Maintenance Associate to maintain provider data accuracy and support network operations. The role involves updating records, ensuring regulatory compliance, and collaborating with Provider Relations, Credentialing, and Contracting teams to ensure timely reimbursements.

The position requires at least 2 years in an office environment, data entry proficiency, and familiarity with provider networks.