Data Entry Specialist

About the Role:

• We are looking for a Provider Data Specialist to join our team.
• The Provider Data Specialist will be responsible for entering and maintaining provider demographic and contractual data within the claims processing system.
• This role will involve working closely with various departments to ensure accurate and up-to-date information is configured within the provider database.

Responsibilities:  

• Maintain provider database using credentialing data, NPPES, and other sources to ensure data integrity within the claims processing system. 
• Enter new contracts into the system and make modifications to existing contracts in collaboration with Network Development.
• Collect IRS W-9 forms from providers to validate/update configured information.
• Coordinate member re-assignment upon termination of a Primary Care Provider (PCP) in collaboration with enrollment operations.
• Select appropriate pricing templates to apply to contracts.
• Update provider records in response to credible allegations of fraud and IRS notices.
• Assist with administrative tasks related to data entry and validation for multiple departments.
• Review provider quality reports and update provider records to meet company standards.
• Assist in developing new policies and procedures as needed.

Education Qualification: - Associate's degree preferred