Sr. Data Mgmt. Rep

Summary

Reviews Provider Records maintained by Tech I. Ensures their eligibility in accordance with network, client and government regulatory guidelines. Ensure accurate updates and maintains provider records within our claims payment systems. Works under general supervision and may provide guidance to lower levels.

Duties

Performs analysis and completes entry into Salesforce for all provider applications and updates including adds, changes, and terminations. Occasionally assists with audit of network provider entry into Facets to ensure accuracy and the integrity of the network provider data. Completes phone verification calls to providers to obtain missing data elements for credentialing and updates as defined by state regulations. Performs routine assignments with minimal supervision.

• Reviews contracted provider data and completes entry into the Salesforce system.
• Verifies provider’s group affiliations.
• Occasionally utilizes NPPES NPI Registry to verify provider NPI and update per NPI website.
• Identifies updates of provider specialty, education, American Board Certification, and state license number and forwards to Credentialing for verification.
• Contacts provider to obtain required data elements to complete provider updates.
• Assists Contract Administrator with maintaining updates to the job aides, makes recommendations for process updates, and maintains updates to the job aides based on recommendations from the Contract Administrator.
• Assists with audit of applications, adds, changes, and terms into the Salesforce and Facets systems and completes audit spreadsheets and provides feed back to the Contract Administrator.
• Reviews and updates error reports received from payers as needed.
• Provides weekly status reports to Contract Administrator to be used for reporting to Supervisor, Provider Relations, and PPO USA.
• Assists with completing provider entry for all applications, adds, changes, and terminations.
• Assists with other tasks as assigned.