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 Data Maintenance Assistant is responsible for overseeing the provider network database across Commercial and Government lines of business. This role entails maintaining database integrity, generating reports, and leading improvement initiatives. Compliance with HEDIS and NCQA standards is crucial, as is managing data elements for Groups, Providers, and Facilities across all serviced states. This position offers an opportunity to contribute significantly to the efficiency and quality of our provider network database.Essential Responsibilities:
Accurately enter and update provider demographic, credentialing, and contract information to maintain current and precise records in the system.
Ensure the addition of accurate contract rows to facilitate proper claims payments and avoid discrepancies.
Verify and confirm licensure, Medicare, and Medicaid eligibility using compliance-approved tools to meet regulatory standards.
Assist in the maintenance and updating of provider directories, ensuring all information remains current and reliable.
Manage and oversee the provider network data maintenance email queue, ensuring timely responses and updates to provider information as required.
Participate in and contribute to data quality initiatives by performing thorough audits and promptly reporting discrepancies to senior team members.
Review and process claims within the Facets system, ensuring they are correctly attached to the appropriate Practitioner, Facility, and/or Group records.
Provide comprehensive administrative support to the Provider Network Maintenance team, including organizing files, preparing detailed reports, and scheduling meetings.
Collaborate closely with and learn from senior team members to gain expertise in data management and provider network operations, while fostering effective working relationships.
Attend and actively participate in training sessions and team meetings to enhance your understanding of the healthcare industry and provider network operations.
Supporting Responsibilities:
Meet department and company performance and attendance expectations.
Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
Perform other duties as assigned.
SUCCESS PROFILEWork Experience: A minimum of 1 year of experience in an office environment is required; Medical office experience preferred.Education, Certificates, Licenses: High School Diploma or equivalent required, Associate’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:AdaptabilityBuilding Customer LoyaltyBuilding Strategic Work RelationshipsBuilding TrustContinuous ImprovementContributing to Team SuccessPlanning and OrganizingWork StandardsEnvironment: 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, TeamworkOur ValuesWe live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business:
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.
