Provider Database Coordinator - JHP

jeffersonhealth; Philadelphia (Philadelphia County); On-site; USD 42,000 - 55,000; Full time

Job summary

Jefferson Health in Philadelphia is seeking a Provider Database Maintenance specialist to ensure accurate provider demographic information across participating and non-participating providers, including physicians, ancillaries, facilities and hospital-based entities.

You will enter new provider data, update fee schedules and pricing/contract details, validate production reports, and support Credentialing, PDC, and Finance service forms while collaborating with internal and external stakeholders.

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.

Responsibilities

• Maintain provider database accuracy and update demographics.
• Enter demographic data of new providers and assign pricing/contract information.
• Update data based on production reports and monitor credentialing/claims mismatches.
• Retrieve, validate and update provider network data and pricing/contract details.
• Collaborate with internal and external customers and participate in staff meetings.

Skills

Database skills

Organizational skills

Written and verbal communication

Teamwork

Independent work

Education

High School Diploma/GED

Tools

Microsoft Outlook

Microsoft Excel

Microsoft Access

Microsoft 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

SummaryWorking 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

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 Address1101 Market, Philadelphia, Pennsylvania, United States of America

Jefferson

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