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Associate Provider Data Integrity Specialist

Company: Blue Cross Blue Shield of Rhode Island
Location: Providence
Posted on: February 16, 2020

Job Description:

Associate Provider Data Integrity SpecialistFull Time - Job ID 999 - Posted: 02/11/2020Job DescriptionManage the development and analysis of the quality and accuracy of provider data. Survey and report against provider data standards for database integrity to ensure the quality of provider file information in support of accurate claims payments and provider directories. Ensure adherence to internal and external standards. Act as back-up for critical provider data functions including, but not limited to, provider file extracts and the provider credentialing process.ESSENTIAL JOB FUNCTIONS:

  • Review and measure the quality of all data in the provider databases through coordination of ongoing quality analysis, verification, and analytical audit activities.
  • Provide ongoing quality control audits and verifications to ensure accuracy and security of data stored in databases.
  • Survey and report against provider data standards for database integrity to ensure the quality of provider file information in support of accurate claims payments and provider directories. Ensure adherence to internal and external standards.
  • Serve as back-up to distribute provider files to support organizational areas in accordance with established time frames and criteria.
  • Serve as back-up for the provider credentialing oversight and completion of administrative tasks associated with the credentialing process.
  • Liaison with provider practices for roster review.
  • Develop communication to providers related to provider data accuracy.
  • Perform other duties as assigned.QUALIFICATIONS:Minimum Education and Experience:
    • Bachelor's degree in Health Services Administration, Computer Science, Information Technology, or related field; or an equivalent combination of education and experience.
    • One to three years of experience in a healthcare field.Preferred Education, Additional Qualifications, and Experience:
      • Knowledge of Facets claims processing systems.
      • Knowledge of credentialing and provider database operations.
      • Knowledge of provider enrollment processes.Required Knowledge, Skills, and/or Abilities:
        • Proficiency with Microsoft suite of products, i.e., Word, Excel, PowerPoint, etc.
        • Strategic and critical thinking skills.
        • Strong analytical skills.
        • Strong written and verbal communication skills.
        • Strong problem-solving skills.
        • Ability to work effectively with a wide variety of people in individual and group settings.
        • Strong organizing skills with the ability to prioritize and respond to shifting deadlines.
        • Strong time management skills.
        • Ability to manage diverse and deadline-oriented workflow.Apply OnlineAt Blue Cross & Blue Shield of Rhode Island (BCBSRI), diversity and inclusion are central to our core values and strengthen our ability to meet the challenges of today's healthcare industry. BCBSRI is an equal opportunity, affirmative action employer. We provide equal opportunities without regard to race, color, religion, age, national origin or ancestry, disability, veteran status, sexual orientation, genetic information, sex, gender identity or expression, and any other personal attributes protected by federal, state, or local law. For more information about our commitment to diversity and inclusion, please see our Diversity Report atbcbsri.com/diversityreport.The law requires an employer to post notices describing the Federal laws prohibiting job discrimination based on race, color, sex, national origin, religion, age, equal pay, disability, veteran status, sexual orientation, and genetic information and gender identity or expression. Please visithttp://www1.eeoc.gov/employers/upload/eeocselfprint_poster.pdfto view the "EEO is the Law" poster.BCBSRI is committed to working with and providing reasonable accommodation to individuals with disabilities. If, because of a disability, you need a reasonable accommodation for any part of our application process, please contact us at (401) 459-1050 for assistance.During the application process, please allow a minimum of five business days before you contact our office to inquire about the status of your application. If you have any questions regarding your application or during the process, please contact Human Resources by phone at (401) 459-1050 or by email ataskhr@bcbsri.org.Southern New England, Boston, MA, Hartford, CT, Health Data Analyst, RI Health Insurer, Healthcare, Wellness, Provider, Network, Rhode Island, RI, Insurance, Certified Professional Medical Services Management, CPMSM, Certified Provider Credentialing Specialist, CPCS, Credential, Credentials, Authorization, Certified Medical Staff Coordinator, CMSC, Enrollment, Administrative, Clerical, Data, Database

Keywords: Blue Cross Blue Shield of Rhode Island, Providence , Associate Provider Data Integrity Specialist, Other , Providence, Rhode Island

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