Provider Data Specialist
Provider Data Specialist
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Job Description
At MVP Health Care were on a mission to create a healthier future for everyone which requires innovative thinking and continuous improvement. To achieve this were looking for a Provider Data Specialist to join #TeamMVP. If you have a passion for data review and attention to detail this is the opportunity for you.
Whats in it for you:
Growth opportunities to uplevel your career
A peoplecentric culture embracing and celebrating diverse perspectives backgrounds and experiences within our team
Competitive compensation and comprehensive benefits focused on well being
An opportunity to shape the future of health care by joining a team recognized as a Best Place to Work for and one of the Best Companies to Work For in New York
Qualifications youll bring:
An associates degree or equivalent combination of education and related experience
The availability to work fulltime virtual within New York State.
Two plus years of experience in health insurance or related office experience.
Detail oriented with excellent data entry skills including a high degree of accuracy.
Excellent computer and database skills including strong knowledge of Microsoft Word and Microsoft Excel.
Previous Credentialing experience preferred. Macess Facets and Catus preferred.
Curiosity to foster innovation and pave the way for growth
Humility to play as a team
Commitment to being the difference for our customers in every interaction
Your key responsibilities:
Excellent member and provider experience accurate and timely onboarding/credentialing and maintenance of provider data ensuring timely payment of claims. Provide excellent customer service for all inquiries and requests. Collaborate with the Network Management to ensure a robust provider network so that members needs are met especially in coverage areas with fewer facilities and providers. Continuously monitor providers performance to ensure quality care for members.
Primarily responsible for provider data entry management verification and maintenance of MVPs Provider and Facility Network.
Credential and recredential providers and facilities in accordance with MVP NCQA CMS NYS Department of Health and all other regulatory agency guidelines.
Review and prepare files including clean files issues and red flag files for the MVP Credentials Committee.
Prepare letters to providers and facilities for credentialing/recredentialing/registration decisions and updates including noncompliance.
Review and Process Provider and MidLevel Registrations in accordance with MVP policies and procedures including but not limited to License Verification DEA review and regulatory sanction checks.
Research and update provider data elements as identified in provider data cleanup projects.
Perform outreach to providers and facilities for required data as needed.
Maintain all provider and facility data in Macess Cactus and Facets systems.
Validate provider education licensure education and training and perform mandated sanction checks such as Licensure DEA or CDS Certificate Board Certification if applicable Medical or Professional education Residency and Fellowship Training if applicable Malpractice Insurance and History Medicare sanctions and opt outs Medicaid Management Information System (MMIS) National Practitioner Identification Number (NPI) through NPPES Social Security Administration Death Master File through the National Technical Information Service (NTIS) database and Clinical Privileges if applicable.
Contribute to our humble pursuit of excellence by performing various responsibilities that may arise reflecting our collective goal of enhancing healthcare delivery and being the difference for the customer.
Where youll be:
Virtual within New York State
Pay Transparency
MVP Health Care is committed to providing competitive employee compensation and benefits packages. The base pay range provided for this role reflects our good faith compensation estimate at the time of posting. MVP adheres to pay transparency nondiscrimination principles. Specific employment offers and associated compensation will be extended individually based on several factors including but not limited to geographic location; relevant experience education and training; and the nature of and demand for the role.
We do not request current or historical salary information from candidates.
MVPs Inclusion Statement
At MVP Health Care we believe creating healthier communities begins with nurturing a healthy workplace. As an organization we strive to create space for individuals from diverse backgrounds and all walks of life to have a voice and thrive. Our shared curiosity and connectedness make us stronger and our unique perspectives are catalysts for creativity and collaboration.
MVP is an equal opportunity employer and recruits employs trains compensates and promotes without discrimination based on race color creed national origin citizenship ethnicity ancestry sex gender identity gender expression religion age marital status personal appearance sexual orientation family responsibilities familial status physical or mental disability handicapping condition medical condition pregnancy status predisposing genetic characteristics or information domestic violence victim status political affiliation military or veteran status Vietnamera or special disabled Veteran or other legally protected classifications.
To support a safe drugfree workplace preemployment criminal background checks and drug testing are part of our hiring process. If you require accommodations during the application process due to a disability please contact our Talent team at.
Other details
- Job FamilyClaims/Operations
- Pay TypeHourly
- Min Hiring Rate$20.00
- Max Hiring Rate$29.00
Required Experience:
Unclear Seniority
Employment Type
Hourly
