Provider Data Analyst Job in San Antonio, Texas US
Tags: applicable contracts, CIP, customer service issues, entry, experience, high school diploma, Information, job, maintenance, provider, provider data, provider education, provider group, refund checks, San Antonio, Texas, V. We
Job Description: POSITION SUMMARY Overall maintenance of provider demographic, billing, and contract information within the company’s claims payment system; including various activities related to the provider network which may include any or all of the following; database maintenance, reporting, and extracting data for various reports and analysis, as well as initiating database improvements Develops and maintains standards for provider data integrity and quality assurance, Conducts audits and provides feedback to reduce errors and improve processes, performance and ensure the quality and consistency of the CIP provider network Maintain accuracy of provider demographics, relationships, and fee schedules in Facets as documented in CIP Ancillary, Provider, Group and other applicable contracts, amendments and addendums.
GENERAL RESPONSIBILITIES Validation of and/or data entry of provider information modifications to the claims payment system Collects, analyzes, interprets, and summarizes provider data in preparation for generation of analytical reports Performance of periodic data audits to assure accuracy of information Analyze provider requests for information updates/changes, and coordinating contact with providers for clarification of discrepancies Documenting and resolving provider customer service issues and inquiries Contribute to the development and maintenance of provider education tools relative to the CIP claims process Attend provider related meetings as necessary Other duties as assigned Assist the Finance, Accounting, Member Services and other CIP departments with provider refund process inquiries Conduct research and analysis for allocation of provider refund checks May be responsible for conducting remedial bank transactions which may include; entry of write-offs, recoveries, and check activity (e.
g., stopped payments, voids, reissues, etc.) REQUIRED EDUCATION AND EXPERIENCE High school diploma required; College degree or completed courses preferred.
Two to three years relevant experience.
Experience in managing physician/healthcare provider information preferred REQUIRED KNOWLEDGE, SKILLS, AND ABILITIES Demonstrated competency in all MS Office products.
Strong analytical skills Experience in healthcare environment helpful Ability to write clear, professional communications for internal and external contacts Excellent written and verbal communication skills Ability to complete tasks in a timely manner Attention to detail is critical Highly accurate and efficient data entry skills Self-motivated and flexible Excellent organizational and time management skills Strong customer service skills We are proud to be an EEO/AA employer M/F/D/V.
We maintain a drug-free workplace and perform pre-employment substance abuse testing.