Provider Database Coordinator

Role Description

Under supervision, the Provider Database Coordinator ensures the accuracy and completeness of provider data as reflected in Health Net’s databases, systems and provider directory. This position works collaboratively with providers, Network Management and Provider Data Services staff to ensure Health Net provider data is current and accurate. Duties include identifying, researching and resolving inconsistent data.

• Responsible for the accuracy and timeliness of Health Net provider data.
• Enters provider data according to established department standards.
• Reconciles data from various data file types to ensure quality results for internal and external customer bases.
• Works with provider offices to assure accuracy of provider data.
• Responds to inquiries and issues related to provider data coming directly from providers and other Network Management staff.
• Works with providers and Provider Relations staff to capture and process provider demographic changes.
• May prepare Inquiry Service Form (ISF) for demographic changes and submits to Provider Data Services for loading in accordance with standard turnaround times.
• Communicates appropriate information/changes to providers to enable timely and accurate claim payment.
• Conducts ongoing monitoring of provider database including data on facilities and physicians.
• Ensures provider directories are current and accurate.
• Facilitates or assists with special projects and other initiatives to ensure provider data is complete and accurate.
• May participate in training and educational activities for providers and internal customers.

Qualifications

• High School diploma required; some college level coursework desirable.
• Three years general data management experience in an automated claims processing, claims research, or provider maintenance environment.
• Two years experience in provider relations, provider contracting; health plan operations or health care/medical office environment.

Requirements

• This is a remote position open to someone working anywhere in the United States, but New Jersey is the preferred location.
• This person will be required to work Eastern Time business hours and occasionally travel to New Jersey.

Benefits

• Competitive pay.
• Health insurance.
• 401K and stock purchase plans.
• Tuition reimbursement.
• Paid time off plus holidays.
• Flexible approach to work with remote, hybrid, field or office work schedules.
• Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status.
• Total compensation may also include additional forms of incentives.
• Benefits may be subject to program eligibility.