Provider Network Data Maintenance Associate

PacificSource Health Plans; Clayton (MO); On-site; USD 36,000 - 57,000; Full time

Job summary

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.

Responsibilities

• 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.

Skills

Accountability

Collaboration

Communication

Flexibility

Listening

Planning

Problem solving

Teamwork

Education

High School Diploma or equivalent

Associate/Bachelor preferred

Tools

Typing

10-key

Job description

Looking for a way to make an impact and help people? Join PacificSource and help our members access quality, affordable care!

PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, sex, sexual orientation, gender identity, national origin, genetic information or age.

PacificSource values the diversity of our community, including those we hire and serve. We are committed to creating and fostering a work environment in which individual differences and diversity are appreciated, respected and responded to in ways that fully develop and utilize each person’s talents and strengths.

The Provider Network Maintenance Associate is responsible for maintaining the accuracy and integrity of provider data within the organization's systems. This role involves updating provider records, ensuring compliance with all regulatory requirements, and supporting Provider Network Operations by managing data related to provider contracts, reimbursements, and credentialing. The Associate will work closely with various teams, including Provider Relations, Provider Reimbursement Analytics, Provider Network Credentialing and Compliance, to ensure that provider information is up-to-date and accurate, which is critical for smooth operations and timely reimbursements.

Essential Responsibilities:

• Accurately and promptly enter and update provider demographic, credentialing, and contract information in PacificSource systems for new and re-credentialed network providers, meeting department service level expectations.
• Process provider additions, terminations, and changes in a timely manner to maintain data integrity and ensure accurate contract rows are added for correct claims payments.
• Perform regular audits of provider data to ensure accuracy, compliance with internal standards, regulatory requirements, and support ongoing maintenance and data integrity of provider information.
• Assist in the management of provider directories, ensuring they are current, accurate, and meet the needs of members.
• Verify licensure, Medicare, and Medicaid eligibility using compliance-approved tools, ensuring provider data meets all regulatory and accreditation standards, including state and federal requirements.
• Support the monitoring and maintenance of provider records for compliance with organizational policies, procedures, and contracting regulations.
• Collaborate with Provider Relations, Credentialing, Contracting, and other internal teams to resolve provider data issues, and research and respond to detailed provider inquiry issues routed from customer/provider service departments.
• Communicate with providers to obtain necessary documentation or clarify discrepancies in data, ensuring positive and effective working relationships.
• Provide support and assistance to other team members as needed to ensure the overall effectiveness of the provider network operations.
• Identify opportunities for process improvements related to provider data management, maintenance, and contribute to quality assurance initiatives to continuously improve data accuracy and process efficiency.
• Assist in the development and implementation of best practices for provider data entry and maintenance, and participate in projects related to provider network expansion, system upgrades, or regulatory changes.
• Maintain positive and effective working relationships with team members and other departments.

Supporting Responsibilities:

• Meet department and company performance and attendance expectations, maintaining a high level of data accuracy and productivity.
• Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
• Perform other duties as assigned, contributing to the overall success of the Provider Network Department.

SUCCESS PROFILE

Work Experience:

A minimum of 2 years of experience in an office environment is required, preferred experience in healthcare data management, network operations or data analysis. Preferred familiarity with provider network operations included, but not limited to, provider credentialing, healthcare regulatory requirements, contracting or reimbursement processes.

Education, Certificates, Licenses:

High School Diploma or equivalent required, Associate’s or Bachelor’s degree preferred.

Knowledge:

Fast and accurate data entry skills. Self-motivated. Able to learn and be trained on new systems, databases, and applications Effective written and oral communication. Proficient computer skills, typing, and 10-key required. Medical terminology, CPT/ICD-10 coding preferred.

Competencies:

• Adaptability
• Building Customer Loyalty
• Building Strategic Work Relationships
• Building Trust
• Continuous Improvement
• Contributing to Team Success
• Planning and Organizing
• Work Standards

Environment:

Work inside in a general office setting with ergonomically configured equipment. Travel may be required 5% of the time for training and/or external meetings.

Skills:

Accountability, Collaboration, Communication (written/verbal), Flexibility, Listening (active), Organizational skills/Planning and Organization, Problem Solving, Teamwork

Compensation Disclaimer

The wage range provided reflects the full range for this position. The maximum amount listed represents the highest possible salary for the role and should not be interpreted as a typical starting wage. Actual compensation will be determined based on factors such as qualifications, experience, education, and internal equity. Please note that the stated range is for informational purposes only and does not constitute a guarantee of any specific salary within that range.

Base Range: $35,542.81 - $56,868.50

Our Values

• We are committed to doing the right thing.
• We are one team working toward a common goal.
• We are each responsible for customer service.
• We practice open communication at all levels of the company to foster individual, team and company growth.
• We actively participate in efforts to improve our many communities-internally and externally.
• We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community.
• We encourage creativity, innovation, and the pursuit of excellence.

Physical Requirements:

Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.

Disclaimer:

This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.