Provider Database Coordinator

jeffersonhealth; Philadelphia (Philadelphia County); On-site; USD 42,000 - 54,000; Full time

Job summary

Jefferson Health is seeking a Provider Database Maintenance Specialist to ensure accurate provider demographics across the network. Under supervision, you will enter new providers, update pricing/contract data, and support credentialing and claims-related processes.

You will review production reports, correct data discrepancies, and collaborate with internal/external stakeholders. The role emphasizes data accuracy, attention to detail, and teamwork in a hospital/health plan environment.

Qualifications

• High School Diploma or GED required.
• Strong data entry and documentation skills.
• Relational database experience preferred in health insurance.
• Proficient with Microsoft Office applications (Outlook/Excel/Access/Word).

Responsibilities

• Maintain and update provider demographic data in the network database.
• Enter new provider records and assign fees schedule and contract information.
• Validate production reports and perform updates for all providers.
• Identify and report problems with provider network database files.
• Collaborate with internal/external customers and participate in meetings/training.

Skills

Database experience

Data entry

Written and verbal communication

Independent/team work

Microsoft Outlook

Microsoft Excel

MS Access

MS Word

Education

High School Diploma or GED

Tools

Outlook

Excel

Access

MS Word

Job description

Number of Positions In Requisition

1

Job Details

Working under the direct supervision of the Supervisor, Provider Database Maintenance, perform provider database maintenance duties to ensure the managed health care system reflects accurate and updated provider demographic information for all participating and non-participating providers. This includes, but is not limited to: Physicians and other Individual Providers Ancillaries Facilities Hospital-based Facility-based

Job Description

Summary

Working under the direct supervision of the Supervisor, Provider Database Maintenance, perform provider database maintenance duties to ensure the managed health care system reflects accurate and updated provider demographic information for all participating and non-participating providers. This includes, but is not limited to: Physicians and other Individual Providers Ancillaries Facilities Hospital-based Facility-based

Job Duties

• Able to work in a constant state of alertness and safe manner
• Maintain and foster a collaborative relationship with internal and external customers.
• Precisely complete all Claims and Reconsideration Service Forms according to department's service-level agreement with Claims
• Precisely complete Credentialing, PDC, and Finance service forms according to expected levels of quality and timeliness
• Enterdemographic dataofnewproviders(asnotedabove)intoprovidernetworkdatabaseandassignfeescheduleandrelatedpricing/contractinformation.
• Makenecessarychangestodemographicandpricing/contractdataforexistingproviders(asnotedabove ).
• Retrieve,validateandperformanynecessaryupdatesbasedonproductionreportsforallprovidersasnotedabove.Reportsinclude,butarenotlimitedto:
• * Credentialing to Claims system mismatch
• * Members attached to terminated PCPs
• *Activeproviderswithsanctions
• * Encountererrors
• Identifyandreportpossibleproblemswiththeprovidernetworkdatabasefiles.
• Participateinongoingprojects,asnecessary,andinstaffand/orcommitteemeetingsandtraining.
• FileproviderinformationanddocumentationindesignatedareasandwithDocumentControl,ifnecessary
• Utilizecredentialingsysteminquiryfunctionstohelpmaintaincorrectdataforparticipatingprovidersintheprovidernetworkdatabase.
• PerformotherjobdutyasrequiredbyNetworkManagement.

Minimum Qualifications

• High School Diploma/GED
• Database, organizational, written and verbal communication skills, and ability to work independently or as part of a team.
• Strong relational database experience, health insurance industry preferred.
• Proficientin Microsoft OutlookandworkingknowledgeofMicrosoftExcelorAccess, andMSWord.

Physical Demands

Lift and carry 25 lbs. frequentsitting/standing, frequent keyboard use, *patient care providers may be required to perform activities specific to theirroleincluding kneeling, bending, squatting and performing CPR.

Job Description Disclaimer:

This position description provides the major duties/responsibilities, requirements and working conditions for the position. It is intended to be an accurate reflection of the current position, however management reserves the right to revise or change as necessary to meet organizational needs. Otherresponsibilities maybeassigned when circumstances require.

Work Shift

Workday Day (United States of America)

Worker Sub Type

Regular

Employee Entity

Health Partners Plans, Inc. Primary Location Address

1101 Market, Philadelphia, Pennsylvania, United States of America

Nationally ranked, Jefferson, which is principally located in the greater Philadelphia region, Lehigh Valley and Northeastern Pennsylvania and southern New Jersey, is reimagining health care and higher education to create unparalleled value. Jefferson is more than 65,000 people strong, dedicated to providing the highest-quality, compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrow's professional leaders for21st-centurycareers; and creating new knowledge through basic/programmatic, clinical and applied research. Thomas Jefferson University , home of Sidney Kimmel Medical College, Jefferson College of Nursing, and the KanbarCollegeofDesign, Engineering and Commerce, dates back to 1824 and today comprises 10 colleges and three schools offering 200+ undergraduate and graduate programs to more than8,300students. JeffersonHealth , nationallyrankedas one ofthe top15 not-for-profit health care systems in the countryandthe largestproviderinthe Philadelphia andLehigh Valley areas, servespatients through millions of encounters eachyearat 32 hospitals campuses and more than 700 outpatient and urgent care locations throughout the region. Jefferson Health Plansis a not-for-profit managed health care organization providing a broad range of health coverage options in Pennsylvania and New Jersey for more than 35years.

Jeffersoniscommitted toprovidingequal