Network Data Specialist

Primary City/State:

Phoenix, Arizona

Department Name:

Provider Data Management

Work Shift:

Day

Job Category:

Information Technology

A rewarding career that fits your life. As an employer of the future, we are proud to offer our team members many career and lifestyle choices including remote work options. If you're looking to leverage your abilities - you belong at Banner Health.

As a Network Data Specialist, you will work off a set list of assigned PDRs and Siebel requests. This is how your work is received to add providers and practitioners into Provider Manager for network adequacy. You will meet every morning with your team for 30 minutes to talk about production and the worklist. You will be expected to lead calls once a month and work with other teams in problem resolution. Other teams you will work with are the IDX and Claims Testing teams and possibly the credentialing teams at times. This is a remote role with a Monday - Friday schedule and hours vary on the team, the earliest start time is (7am AZ time,) with no holidays requirements. There are some Overtime options available but it's only volunteer basis.

Banner Health Network (BHN) is an accountable care organization that joins Arizona's largest health care provider, Banner Health, and an extensive network of primary care and specialty physicians to provide the most comprehensive healthcare solutions for Maricopa County and parts of Pinal County. Through BHN, known nationally as an innovative leader in new health care models, insurance plans and physicians are coming together to work collaboratively to keep members in optimal health, while reducing costs.

POSITION SUMMARY

This position provides file maintenance of the provider database. Ensures accuracy of high volume data and maintenance of provider demographic and contract files. Interprets provider contractual language and interprets guidelines. Maintains proper record keeping of all system support files.

CORE FUNCTIONS

1. Maintains 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.

2. Provides information to appropriate personnel in regard to changes and updates in system support files.

3. Assist in education of providers, hospitals and the internal and external staff on demographic and network data requirements.

4. Identifies, assists, and resolves managed care issues concerning claims, contract interpretation, eligibility and general provider demographic operational issues.

5. May communicate with network providers and staff and inform them of any operational, procedural, and contractual changes and updates.

6. Assists internal departments in resolving provider and member appeals pertaining to the physician, ancillary providers and hospital network arrangements and plan contracts.

7. Maintains accurate and current provider information and provides system support in provider network development.

8. Assists with reporting network development needs in various geographic regions. Completes managed care contracts updates in the Impact system for payors and providers. Creates and processes required provider statistics and reporting.

9. Assists in the system development and maintenance for a designated comprehensive provider network of physicians and hospitals. Under limited supervision, responds to and resolves issues related to the daily administration of demographic data for potential and existing providers and non-contracted providers. Customers may include Network Providers, Payors, Physicians and internal Provider Relations and Claims Reimbursement team members.

MINIMUM QUALIFICATIONS

Strong knowledge and understanding of healthcare planning as normally demonstrated through a minimum of one year of provider network planning and/or process management or operations experience.

Requires strong Excel knowledge, ability to analyze statistical data, and the ability to work on a variety of projects in an organized fashion. Must possess a strong knowledge of business and/or healthcare as normally obtained through provider relations experience or healthcare provider file maintenance experience.

Must have an understanding of managed care reimbursement strategies and methodologies for physicians, hospitals and ancillary providers. Must be able to communicate effectively with others by speaking, reading, and writing.

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.

Additional related education and/or experience preferred.

EOE/Female/Minority/Disability/Veterans

Our organization supports a drug-free work environment.

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