[Remote] Provider Data Specialist

Note: The job is a remote job and is open to candidates in USA. TriWest Healthcare Alliance is dedicated to serving veterans and their families by connecting them to healthcare services. The Provider Data Specialist role focuses on maintaining and synchronizing provider data across systems, ensuring accuracy, and communicating with clients to resolve data issues.

Responsibilities

• Process provider data inventory within expected timeline while meeting accuracy and production targets
• Identify, research, and analyze issues received to determine appropriate handling
• Resolve provider data correction requests in a specified time frame
• Manage daily follow up of Provider data correction requests and resolve all issues to ensure databases are current and accurate
• Maintain and process reimbursement terms to ensure correct claims payment and downstream processing
• Review Provider contract language and identify when the contract is out of compliance
• Process Provider contracts, run reports and respond to inquiries regarding contract compliance issues; image and index contracts and return images to network subcontractors
• Conduct quality assurance activities to ensure image quality and completion of image activities
• Support requests for assistance and research issues using various resources including online searches and phone calls
• Communicate clearly through both written and verbal forms of communication and follow up with various parties to ensure tasks are completed within the allotted timeline or issues are escalated appropriately
• Coordinate with internal departments for provider database related issues
• Perform all other related duties as assigned by supervisor
• Regular and reliable attendance is required

Skills

• High School Diploma or GED
• U.S. Citizenship
• Must be able to receive a favorable Interim and adjudicated final Department of Defense (DOD) background investigation
• One year experience in a customer service role or administrative support work requiring data entry work
• Proficiency in using Microsoft Office products and the Internet
• 2 years of data entry experience
• Healthcare industry experience, including knowledge of health services

Benefits

• Medical, Dental and Vision Coverage
• Paid time off
• 401(k) Retirement Savings Plan (with matching)
• Short-term and long-term disability, basic life, and accidental death and dismemberment insurance
• Tuition reimbursement
• Paid volunteer time

Company Overview