Provider Network Data Integrity Specialist

PacificSource Health Plans; Clayton (MO); Sur place; USD 36 000 - 57 000; Plein temps

Résumé du poste

PacificSource Health Plans is seeking a Provider Network Maintenance Associate in Clayton, MO to maintain provider records, ensure data accuracy, and support regulatory compliance. The role collaborates with Provider Relations, Credentialing, and Contracting teams to ensure timely reimbursements and data integrity.

The position requires at least 2 years in an office setting and a high school diploma (associate/bachelor preferred).

Qualifications

• Minimum 2 years of office experience; healthcare data background preferred.
• High School Diploma or equivalent required; Associate/Bachelor preferred.
• Fast and accurate data entry; able to learn new systems.
• Proficient typing and 10-key; basic medical terminology helpful.

Responsabilités

• Enter and update provider demographic, credentialing, and contract data in PacificSource systems; meet service level expectations.
• Process provider additions, terminations, and changes to maintain data integrity and correct claim payments.
• Regularly audit provider data for accuracy, regulatory compliance, and ongoing maintenance.
• Assist in managing provider directories to keep them current and accurate.
• Verify licensure, Medicare, and Medicaid eligibility using approved tools; ensure regulatory standards.
• Support monitoring of provider records for policy and contracting compliance.
• Collaborate with internal teams to resolve data issues and respond to provider inquiries.

Connaissances

Accountability

Collaboration

Communication

Flexibility

Listening

Planning

Problem solving

Teamwork

Formation

High School Diploma or equivalent

Associate/Bachelor preferred

Outils

Typing

10-key

Description du poste

PacificSource Health Plans is seeking a Provider Network Maintenance Associate in Clayton, MO to maintain provider records, ensure data accuracy, and support regulatory compliance. The role collaborates with Provider Relations, Credentialing, and Contracting teams to ensure timely reimbursements and data integrity.

The position requires at least 2 years in an office setting and a high school diploma (associate/bachelor preferred).