Provider Data Specialist

Apply on line at http://www.alohacare.org/Careers/Default.aspx

The Company

AlohaCare is a local, non-profit health plan serving the Medicaid and Medicare dual eligible population. We provide comprehensive managed care to qualifying health plan members through well-established partnerships with quality health care providers and community-governed health centers. Our mission is to serve individuals and communities in the true spirit of aloha by ensuring and advocating access to quality health care for all. This is accomplished with emphasis on prevention and primary care through community health centers that founded us and continue to guide us as well as with others that share our commitment. As Hawaii’s third-largest health plan, AlohaCare offers comprehensive prevention, primary and specialty care coverage in order to successfully build a healthy Hawaii.

The Culture

AlohaCare employees share a passion for helping Hawaii’s most underserved communities. This passion for helping and caring for others is internalized and applied to our employees through a supportive and positive work environment, healthy work/life balance, continuous communication and a generous benefits package.

AlohaCare’s leadership empowers and engages its employees through frequent diversity, recognition, community, and educational events and programs. AlohaCare has a strong commitment to support Hawaii’s families and reinforces a healthy work/home balance for its employees. Because AlohaCare values honesty, respect and trust with both our internal and external customers, we encourage open-door, two-way communication through daily interactions, employee events and quarterly all-staff meetings. AlohaCare’s comprehensive benefits package includes low-cost medical, dental, drug and vision insurance, PTO program, 401k employer contribution, referral bonus and pretax transportation and parking program.

These employee-focused efforts contribute to a friendly, team-oriented culture which is positively reflected into the communities we serve.

The Opportunity

To coordinate a demanding workload serving as the primary data entry point for provider data into QNXT. This position requires the use of judgment and initiative to determine the best approach or action for non-routine situations, and it includes detailed and focused tasks that must be completed with a high degree of efficiency and accuracy. Tasks include handling confidential information that must be continuously safeguarded.

Primary Duties And Responsibilities

• Perform initial and updated provider data entries and contract designations in QNXT with a high degree of accuracy.
• Conduct research in Provider and Claims Modules of QNXT to determine how or why related data may be causing delays to claim processing
• Complete necessary QNXT entries and/or make adjustments to the Provider Module to allow pended claims to process
• Ensure that the section of the Local Use Report assigned to the Credentialing & Provider Data Department is cleared and corrected in a timely manner
• Provide related information and status updates to the Provider Relations Department and other AlohaCare departments as needed
• Advise and consult with the department Supervisor and Credentialing Coordinator Lead regarding provider contract set-up and configuration in QNXT
• Consult with Credentialing Coordinator Lead on new and re-credentialed providers and demographic updates from Credential Stream.
• Act as the department “Super User” for QNXT system changes, attending all meetings and trainings and thereafter training department staff
• Organize and prioritize workload daily.
• Appropriately safeguard all confidential provider data at all times
• Provide back-up assistance for other provider data management and credentialing tasks as needed
• Other duties as assigned
• Responsible to maintain AlohaCare’s confidential information in accordance with AlohaCare policies, and state and federal laws, rules and regulations regarding confidentiality. Employees have access to AlohaCare data based on the data classification assigned to this job title.
  
  

Required Competencies And Qualifications

• Two - three years of clerical experience.
• Data entry experience with a high degree of accuracy and attention to detail.
• An understanding of medical professional specialties, academic degrees, and contract terms.
• Working knowledge of Microsoft Office.
• Strong oral, written and interpersonal communication skills, including telephone etiquette.
• Good organizational, time management and analytical skills.
• Flexibility and adaptability to changing priorities.
• Positive attitude and ability to accept direction.
• Ability to work with different people and personalities.
  
  

Required Licensure/Certification/Education

• High school diploma or equivalent combination of education and experience.
  
  

Preferred Competencies And Qualifications

• Word processing skills of 45-60 wpm with a high degree of accuracy.
• Familiar with Trizetto programs
• Familiar with Contracting processes and procedures.
  
  

Additional Job Requirements

• Ability to concentrate for long periods of time.
• Attention to detail.
• Other miscellaneous duties as required
  
  

Equipment/Resources Used

• Computer workstation with dual screen configuration
• Telephone
• AlohaCare Policy and Procedure Manual
  
  

Salary Range: $16.50 - $22.00 an hour

AlohaCare is committed to providing equal employment opportunity to all applicants in accordance with sound practices and federal and state laws. Our policy prohibits discrimination and harassment because of race, color, religion, sex (including gender identity or expression), pregnancy, age, national origin, ancestry, marital status, arrest and court record, disability, genetic information, sexual orientation, domestic or sexual violence victim status, credit history, citizenship status, military/veterans status, or other characteristics protected under applicable state and federal laws, regulations, and/or executive orders.