Provider Database Coordinator - JHP

Health Partners Plans, Inc.; Jefferson Center (PA); On-site; USD 45,000 - 65,000; Full time

Benefits offered by this job

Medical Insurance

Dental Insurance

Vision Insurance

Retirement Plans

Tuition Assistance

Disability Insurance

Job summary

Health Partners Plans, Inc. is seeking a Provider Database Maintenance role to ensure accurate provider demographics across participating and non-participating providers.

The position involves data entry, updates, and ensuring pricing/contract information aligns with the network. The ideal candidate will have high school completion, database experience, and strong Microsoft Office skills, with a preference for health insurance industry familiarity.

Qualifications

• High School Diploma/GED required.
• Relational database experience preferred.
• Strong written and verbal communication skills.
• Ability to work independently or as part of a team.
• Experience with health insurance provider data is a plus.

Responsibilities

• Maintain provider demographics for all participating and non-participating providers in the network.
• Enter, verify, and update provider data in the network database.
• Process credentialing, PDC, and finance service forms per SLAs.
• Review production reports and update data as needed for accuracy.
• Identify and report issues in the provider network database.

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 Duties

Ability 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.

Enter demographic data of new providers (as noted above) into provider network database and assign fee schedule and related pricing/contract information.

Make necessary changes to demographic and pricing/contract data for existing providers (as noted above).

Retrieve, validate and perform any necessary updates based on production reports for all providers as noted above. Reports include, but are not limited to:

• Credentialing to Claims system mismatch
• Members attached to terminated PCPs
• Active providers with sanctions
• Encounter errors

Identify and report possible problems with the provider network database files.

Participate in ongoing projects, as necessary, and in staff and/or committee meetings and training.

File provider information and documentation in designated areas and with Document Control, if necessary.

Utilize credentialing system inquiry functions to help maintain correct data for participating providers in the provider network database.

Perform other job duties as required by Network Management.

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.

Proficient in Microsoft Outlook and working knowledge of Microsoft Excel or Access, and MS Word.

Physical Demands

Lift and carry 25 lbs. frequent sitting/standing, frequent keyboard use.

Patient care providers may be required to perform activities specific to their role including 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. Other responsibilities may be assigned 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.

Company Overview

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 for 21st-century careers; 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 Kanbar College of Design, Engineering and Commerce, dates back to 1824 and today comprises 10 colleges and three schools offering 200+ undergraduate and graduate programs to more than 8,300 students.

Jefferson Health, nationally ranked as one of the top 15 not-for-profit health care systems in the country and the largest provider in the Philadelphia and Lehigh Valley areas, serves patients through millions of encounters each year at 32 hospitals campuses and more than 700 outpatient and urgent care locations throughout the region.

Jefferson Health Plans is a not-for-profit managed health care organization providing a broad range of health coverage options in Pennsylvania and New Jersey for more than 35 years.

Jefferson is committed to providing equal educational and employment opportunities for all persons without regard to age, race, color, religion, creed, sexual orientation, gender, gender identity, marital status, pregnancy, national origin, ancestry, citizenship, military status, veteran status, handicap or disability or any other protected group or status.

Benefits

• Medical (including prescription)
• Supplemental insurance
• Dental
• Vision
• Life and AD&D insurance
• Short- and long-term disability
• Flexible spending accounts
• Retirement plans
• Tuition assistance
• Voluntary benefits (which provide colleagues with access to group rates on insurance and discounts)
• Tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service
• Medical (including prescription) insurance for all colleagues, including those who work less than part-time (including per diem colleagues, adjunct faculty, and Jeff Temps)

Career Development

In keeping with Jefferson's Mission, We Improve Lives, it is our goal to recruit, retain, develop and reward highly-qualified employees. If you are enthusiastic, caring and dedicated to service excellence, we invite you to consider joining Jefferson. Jefferson encourages its employees to expand their knowledge and develop their careers through growth opportunities and continuing education.

With a long standing history, Jefferson has been advancing the medical field from the heart of Center City Philadelphia for nearly 200 years. Our Mission, We Improve Lives, expands to every corner of the organization. From our weekly farmer’s market, to our new Jefferson Accelerator Zone for innovation, our employees’ passion for the community is evident by the daily gestures towards our patients, students and each other.