Provider Data Specialist


PROVIDER DATA SPECIALIST

  • Work from Home

JOB DESCRIPTION

BroadPath Healthcare Solutions is hiring a team of work from home Network Data Specialists. The sensitive nature of the Network Data Specialist position requires discretion and the ability to retain confidentiality of information obtained by discussions or recorded data. As a work from home associate, BroadPath will provide you with a Laptop, 4 Port USB Hub, Bhive Web Camera, and USB Headset. Come join the BroadPath team as a Network Data Specialist!

RESPONSIBILITIES

Our Network Data Specialists will ensure accuracy of high-volume data, as well as maintenance of provider demographic and contract files. Network Data Specialists will interpret provider contractual language and guidelines.

  • Maintain current and validated provider demographics, networks, tax identification, 1099 data, Medicare certification and NPI data in the system with a high level of accuracy and meeting minimum productivity requirements
  • Effective listening and analytical skills, as well as the ability to summarize information and offer solutions
  • Assist in education of providers, hospitals and the internal and external staff on demographic and network data requirements
  • Ensures compliance to policies, procedures, and state and federal regulations
  • Assist internal departments in resolving provider and member appeals pertaining to the physician, ancillary providers and hospital network arrangements and plan contracts
  • Assist with reporting network development needs in various geographic regions. Completes managed care contracts updates in the Impact system for payers and providers. Creates and processes required provider statistics and reporting
  • Identify, assist, and resolve managed care issues concerning claims, contract interpretation, eligibility and general provider demographic operational issues
  • Ensure compliance with BroadPath, Client, and HIPAA regulations
  • Review and Agree to BroadPath’s Bhive Agreement
  • Participate and Collaborate in BroadPath’s Bhive Engagement Platform

BASIC QUALIFICATIONS

  • 2 years of recent experience working with provider demographics in a Network Data Specialist/Provider Data Specialist role
  • Must have strong understanding of managed care reimbursement strategies and methodologies for physicians, hospitals and ancillary providers
  • Must possess strong knowledge of business and/or healthcare as normally obtained through provider relations experience or healthcare provider file maintenance experience
  • Strong communicator; ability to communicate clearly via written or verbal communication
  • Strong Excel knowledge; with ability to analyze statistical data
  • Reliable internet with 5 Mbps download and 2 Mbps upload speed (we provide you with the equipment)

PREFERRED QUALIFICATIONS

  • Bachelor’s degree in business, healthcare administration, or related field
  • One year of medical claims auditing and or provider data demographic processing experience and an understanding of medical terminology and knowledge of CPT-4 and ICD-9 coding
  • Portico system experience
  • SharePoint system experience


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BroadPath Healthcare Solutions

BroadPath
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