Provider Data Maintenance Spec

CareAllies Inc.; United States; Remote; USD 26,000 - 47,000; Full time

Benefits offered by this job

Health and wellness benefits

401(k) savings plan

Pension plan

Paid time off

Paid parental leave

Disability insurance

Life insurance

Employee assistance program

Paid holidays

Tuition reimbursement

Job summary

CareAllies Inc. is seeking a detail-oriented professional to analyze and apply business rules for provider data changes impacting claims, enrollment, and directory services.

You will review contracting and credentialing while maintaining provider data to support networks across lines of business. Role requires collaboration with internal teams and external partners, including coordinating with various departments on network activities.

Qualifications

• 2 years of college and/or 2 years of relevant experience.
• Written and verbal communication skills to interact with internal and external customers.
• Analytical and quantitative skills.
• Ability to take initiative and work independently.

Responsibilities

• Analyze and apply business rules for provider data changes affecting claims processing, enrollment, and directory services.
• Review contracting, credentialing, and maintenance of provider data to support multiple departments.
• Coordinate with internal teams and external partners as liaison for network activities.

Skills

Analytical skills

Communication skills

Independent work

Spanish preferred

Education

2-year college or equivalent

Tools

Salesforce

Excel

Access

PowerPoint

Job description

Job Summary

This position is responsible for the analyzing, researching, and applying business rules to complete requests received from providers regarding adds/deletes/changes to their information used for claims processing, membership assignment, and directory purposes. Review contracting, credentialing, and maintenance of Provider Data to support Claim’s payment, Marketing, Membership and Network Contracting across all lines of business. This includes providing accurate and timely administration of provider contracts, rosters and requests supporting quality initiatives to ensure data accuracy. Responsibilities including internal provider meetings and work groups, researching problems related to provider credentialing, data and network participation. Includes working as a Liaison between Network Contracting, Enterprise Credentialing, Product Development, Special Investigations Department, Legal, Marketing, Full Service Units, ITG, Government Programs, and other business partners on network activities. *** The ideal candidate for this position must reside within a reasonable commute distance to the El Paso, Texas local office.

Required Job Qualifications:

• 2 years of college and/or 2 years of relevant experience
• Written and verbal communication skills to interact with internal and external customers
• Analytical and quantitative skills
• Ability to take initiative and work independently

Preferred Job Qualifications:

• Working knowledge of Professional Provider Credentialing Process
• 1 year of experience on the Provider Data
• Experience with Microsoft Office applications including Excel, Access, and Power Point
• Bilingual Spanish highly preferred, but not required
• Experience using SalesForce a plus

This position may be performed remotely from anywhere within the continental United States, excluding California, New York, Alaska, and Hawaii.

EEO Statement:

We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics. We are a drug-free and smoke-free workplace. Employment may be contingent upon successful completion of drug screening in accordance with applicable law.

Pay Transparency Statement:

At CareAllies, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work.

• health and wellness benefits
• 401(k) savings plan
• pension plan
• a minimum of 15 days’ of paid time off
• paid parental leave
• disability insurance
• supplemental life insurance
• employee assistance program
• paid holidays
• tuition reimbursement
• plus other incentives

we offer a robust total rewards package for full-time employees. The salary offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan.

Min to Max Range: $19.13 - $34.17 Exact compensation may vary based on skills, experience, and location.

Join our talent community and receive the latest CareAllies news, content, and be first in line for new job opportunities.

Join our Talent Community.

Across 1600+ locations in 11 states, CareAllies is helping physicians make a difference in the lives of over 400,000 patients every day. Our mission is to unlock value, quality, and population health outcomes for physicians and health plans by simplifying a complex care environment and elevating clinical results. Innovista Health is a subsidiary of Health Care Service Corporation.