Provider Data Specialist

Job Description

Job Description

Arizona Priority Care (AZPC) is an Integrated Provider Network focused on providing whole-person care to Senior and Medicaid populations, through advanced value-based models. Our provider network is comprised of more than 6,000 health care providers, including primary and specialty care physicians, hospitals and ancillary providers. We have operated in the Arizona market for more than 14 years, based in Chandler, Arizona, and are an affiliate of Heritage Provider Network. As a leading value-based provider organization, we are committed to improving the quality of care, providing excellent member and provider experiences all while reducing cost.

The Provider Data Specialist is responsible for the entry and maintenance of provider and vendor data in EzCap.

1. POSITION DUTIES & RESPONSIBILITIES

• Ensure that all required data such as NPI, License, primary specialty taxonomy code, OIG LEIE, certifications and accreditations are researched and recorded in the appropriate fields of the provider record.
• Ensure that the provider data entered meets the format standards set by AZPC.
• Run reports to identify providers and vendors records that do not meet the established data or format requirements.
• Run SQL queries in EzCap to identify claims requiring provider or vendors additions.
• Update provider contract status information upon receiving notice of contract effective date or contract termination date.
• Run reports to identify claim errors that require provider data update for error resolution, including by not limited to Providers Health Plan Panel is not in effect on Service Date or Provider Contract Not in Effect on Date of Service.
• Maintain knowledge and understanding of contracts, Division of Financial Responsibility (DOFR), Network Areas and coverage area.
• Update vendor remittance addresses as required. Document the source of the updated information in the vendor notes. Valid sources include notification from the provider, forwarding orders received from the USPS and forwarding address information received from RedCard.
• Note the receipt of a W9 in the vendor notes. Compare Business Name, mailing address and SSN/EIN information on the W9 with the information entered in EzCap. Make changes if required in EzCap and have the W9 scanned to Document Management.
• Run reports and add/edit data in a timely manner.
• Other duties and projects as assigned.

1. EDUCATION, TRAINING AND EXPERIENCE

• High school diploma or equivalent (GED)
• Minimum 1 year of experience using EzCap, ExCel and Crystal Reports
• Minimum 1 year experience processing claims
• Minimum 1 year experience in the medical or health related field
• Knowledge of Medicare rules, medical terminology, and managed care health plan rules and regulations, contracts, DOFR's, ICD-9, CPT and RVS codes.
• Must be proficient in typing and detail oriented
• Ability to work independently and under pressure

Ability to interact effectively with patients and professionals