Provider Data Quality Coordinator

Job Type
Full-time
Description
The Position.
The Provider Data Quality Coordinator plays a role in maintaining accuracy and updating of Provider Data within the organization's systems and assisting the Credentialing Specialists. This involves managing the collection, validation, and maintenance of provider information while ensuring compliance with regulatory and accrediting bodies. Additionally, this role will also assist in credentialing and provider enrollment duties, ensuring accurate practitioner information within the database. They also contribute to pulling necessary reports for the Provider Services Department and engage in other clerical and administrative tasks as assigned. Occasionally, this position may travel to providers' offices for credentialing purposes, but advance notification will be provided. Overall, this position is essential for upholding Provider Data Quality standards within the database systems.
The Specs.

• Non-Exempt.
• Hybrid: In-office and Remote.
• Full-Time.
• Benefits-Eligible: PTO, PSL, Holidays, Medical, Dental, Vision, 401(K), etc.
• Wage Range: $20 - $25 per hour; bi-weekly payroll.

The Duties.
•Monitors Credentialing email and acts on all requests.
•Assist in entering all new and existing credential requests into the system and file requests according to company policy.
•Manage tracking of all new requests and provider recredentialing utilizing company's preferred software platform.
•Reviews initial paperwork and applications to identify possible issues and follows up with the healthcare provider as needed to obtain any missing or additional information.
•Maintain Provider CAQH profiles to ensure they are updated and attested to prior to sending new requests.
•Track and monitor Recredentialing cycles and send Recredentialing letters to any Providers who require in-house credentialing or have not maintained their CAQH Profile.
•Maintains the credentialing database to ensure required demographics and information is entered and stored correctly.
•Manages credentialing and enrollment timelines and communicates with necessary stakeholders as to status and barriers.
•Escalate any identified credentialing delays and issues to management which impact schedule timelines, regulatory compliance, and priority requests.
•Send welcome letters and answer any inquiries during the credentialing process.
•Manage filing of Credentialing packets and submission to clients on quarterly basis
•Manage Expirables.
•Responds to internal and external inquiries on application and enrollment matters.
•Establishes and maintains positive and close working relationships with internal and external stakeholders.
•Participates in staff meetings and continuing education, and recommends new approaches, policies, and procedures to effect continual improvement in efficiency of the department and services performed.
•Assist internal and external audits when needed regarding credentialing/re-credentialing process.
•Conduct routine data audits to identify discrepancies, inaccuracies, and inconsistencies in Provider Data.
•Update all changes to existing Providers, which includes Adds, Terms, and updates.
•Run Health Plan/Group Rosters on a monthly and quarterly basis as requested by Health Plan.
•Submit requests for PCP ID's and any updates about PCP's to Health Plans and ensure Client receives ID's once available.
•Collaborate with internal teams to resolve data discrepancies and improve Data Quality processes.
•Participate in system enhancements and optimization efforts to improve efficiency and accuracy in Provider Data management.
•Create and run reports needed by Provider Services as needed or scheduled.
•Provide support to internal staff members involved in Provider Data management processes to ensure adherence to Data Quality standards and procedures.
•Other duties and projects assigned.
IMS offers competitive compensation depending on experience. We are an equal opportunity employer and seek diversity in our workforce. IMS is also an E-Verify Employer. To learn more about E-Verify and your rights and responsibilities, please visit: https://www.e-verify.gov/employees/employee-rights-and-responsibilities .
Requirements
The Education.
•Associate degree or equivalent experience.
The Experience.
•1+ years in a health plan, managed service organization or Provider/Hospital setting, preferred.
The Skills/Knowledge/Abilities/Other Attributes.
•Strong communication skills for internal and external collaboration.
•Knowledge in credentialing and re-credentialing process, preferred.
•Ability to interact with physicians, contractors, and all levels of management.
•Always maintain strictest confidentiality according to company Confidentiality Agreement and federal and state laws and regulations, such as HIPAA.
•Accurate data-entry and good typing skills.
•Tech-savvy and proficient in computer skills.
•Familiarity in IPA, MSO, Heath Plan industry.
•Attention to detail to meticulously review and maintain accurate Provider Data, ensuring all information is complete and up to date.
•Analytical skills to identify discrepancies, trends, or patterns to improve Data Quality processes.
•Strong technical proficiency.
•Strong organizational skills to be able to multi-task, prioritize, and meet deadlines in a fast-paced environment.
•Time Management to ensure tasks are completed within specified timelines.
•Ability to audit internal data.
•Team collaboration skills.
* Please note that the duties and responsibilities outlined above are summarized and may not encompass all tasks associated with the position. The nature of the role may require adaptation to changing circumstances and additional responsibilities not explicitly mentioned here. The organization reserves the right to modify, interpret, or supplement the job duties as needed.
Salary Description
$20 - $25 per hour, or depending on experience.