Provider Database Coordinator

Provider Database Maintenance

Working under the direct supervision of the Supervisor, Provider Database Maintenance, perform provider database maintenance duties to ensure the managed health care system reflects accurate and updated provider demographic information for all participating and non-participating providers. This includes, but is not limited to: Physicians and other Individual Providers Ancillaries Facilities Hospital-based Facility-based Job Duties

Able to work in a constant state of alertness and safe manner

Maintain and foster a collaborative relationship with internal and external customers.

Precisely complete all Claims and Reconsideration Service Forms according to department's service-level agreement with Claims

Precisely complete Credentialing, PDC, and Finance service forms according to expected levels of quality and timeliness

Enter demographic data of new providers (as noted above) into provider network database and assign fee schedule and related pricing/contract information.

Make necessary changes to demographic and pricing/contract data for existing providers (as noted above).

Retrieve, validate and perform any necessary updates based on production reports for all providers as noted above. Reports include, but are not limited to: * Credentialing to Claims system mismatch * Members attached to terminated PCPs * Active providers with sanctions * Encounter errors

Identify and report possible problems with the provider network database files.

Participate in ongoing projects, as necessary, and in staff and/or committee meetings and training.

File provider information and documentation in designated areas and with Document Control, if necessary

Utilize credentialing system inquiry functions to help maintain correct data for participating providers in the provider network database.

Perform other job duties as required by Network Management.

Minimum Qualifications

High School Diploma/GED

Database, organizational, written and verbal communication skills, and ability to work independently or as part of a team.

Strong relational database experience, health insurance industry preferred.

Proficient in Microsoft Outlook and working knowledge of Microsoft Excel or Access, and MS Word.

Physical Demands Lift and carry 25 lbs. frequent sitting/standing, frequent keyboard use, *patient care providers may be required to perform activities specific to their role including kneeling, bending, squatting and performing CPR.

Work Shift

Workday Day (United States of America)

Worker Sub Type

Regular

Employee Entity

Health Partners Plans, Inc.

Primary Location Address

1101 Market, Philadelphia, Pennsylvania, United States of America