What are the responsibilities and job description for the Provider Data Maintenance Specialist position at Driscoll Children's Hospital?
Where compassion meets innovation and technology and our employees are family.
Thank you for your interest in joining our team! Please review the job information below.
GENERAL PURPOSE OF JOB:
The Provider Data Maintenance Specialist is responsible for researching and gathering provider data and converting it into meaningful information/reports/file used by the Driscoll Health Plan in the Tapestry claim system.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This job description is not intended to be all-inclusive; employees will perform other reasonably related business duties as assigned by the immediate supervisor as required.
Thank you for your interest in joining our team! Please review the job information below.
GENERAL PURPOSE OF JOB:
The Provider Data Maintenance Specialist is responsible for researching and gathering provider data and converting it into meaningful information/reports/file used by the Driscoll Health Plan in the Tapestry claim system.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This job description is not intended to be all-inclusive; employees will perform other reasonably related business duties as assigned by the immediate supervisor as required.
- Maintains utmost level of confidentiality at all times.
- Adheres to hospital policies and procedures.
- Demonstrates business practices and personal actions that are ethical and adhere to corporate compliance and integrity guidelines.
- Ensures the integrity of provider data, including research, data extraction, processing, storage, manipulation, analysis, and distribution of Provider Data from Credentialing, Contracting and State and Federal databases.
- Change Files ensuring data integrity of all provider data being loaded into DHP, claims and authorizations systems.
- Provides resolution of all DHP Claims Provider Not Found Queues to required Provider data for adjudication on a Participating or Non-participation basis expeditiously as required to meet state-mandated claims turnaround time frames.
- Proficient in use of the State of Texas Master Provider File (MPF) and NPPES NPI Registry in regard to Provider Data required to load Provider information.
- Utilizes DHP CRM to communicate with DHP Departments to provide required provider data to the appropriate department for system load.
- Performs other related work as required.
- Any combination of education and experience that would likely provide the required knowledge, skills, and abilities is qualifying. Degree Preferred.
- Typically has 6 years’ experience in Texas Medicaid MCO Provider data Management.
- Knows fundamental concepts, practices and procedures of particular field of specialization.
- Preferred healthcare industry experience or related experience, prior experience working with Medicaid Managed Care claims system a plus.
- Experience with relational database querying tools and critical thinking skills to determine the appropriate course of action to meet Provider Data Load Requirements.
