Provider Network Data Maintenance Associate

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 inq To view the full job description please use the link below. https://www.aplitrak.com/?adid=YmJnZW5lcmljLjEzNjQ2Ljg3NjRAcGFjaWZpY3NvdXJjZWNvbXAuYXBsaXRyYWsuY29t