Job Abstract

JOB PURPOSE:

Reporting to the Director of Provider Data Operations & Network Analytics, the Provider Data Network Specialist supports the management and maintenance of CenterLight Healthcare’s network data, its integrity, and its compliance. This role will be responsible for supporting and processing provider data files, system updates, network analyses, DOH reporting, ad-hoc internal reporting, external reporting, and quality assurance/auditing.

JOB RESPONSIBILITIES:

• Network data collection, standardization, and management using specialized tools

• Timely data file processing for system uploads based on contracted provider files and contracts

• Manage confidential information of internal staff (Physicians, Nurse Practitioners).

• Triage regular and troubleshoot ad-hoc provider network data/system cleaning, loading, and reporting requests for internal and external stakeholders

• Support file transfers to third party vendors

• Develop and conduct data validation processes and data auditing with responsibility for process improvement strategies

• Support preclusion, exclusion, and other sanction list processing to ensure network compliance

• Maintain a record of inaccuracies and follow-up on sensitive information with providers

• Develop and maintain rolling issues list

• Support provider network oversight processes (e.g., maintaining network adequacy, regular and ad-hoc audits, etc.)

• Highlight system and process issues and support remediation efforts through problem-solving, tool development, etc.

• Work with sensitive or proprietary information with discretions and professional judgment for different internal and external stakeholders

• Perform other responsibilities as assigned

Weekly Hours: 40

Schedule: 8:30 AM - 5:30 PM

QUALIFICATIONS:

Education:

• Bachelor’s degree or equivalent experience in healthcare administration, public health, systems information, or other related fields with 3-5 years of data management and analysis experience.

Experience:

• Required: Data management, data operations/analytics, quality, process improvement, and project management skills required. Working knowledge of Medicare and Medicaid is required. Ability to efficiently standardize and reconcile disparate data effectively. Advanced Microsoft Excel skills required. Effective oral, written, and interpersonal communication skills are required.

• Preferred: health plan/managed care setting

License/Registration:

• Required: None

Other:

• Proficient in Microsoft Office applications with advanced Excel skills.

• Detail-oriented and effective communicator.

• Discretion with highly sensitive information, including credentialing files, sanction lists, claims, and remittance information

• Able to multitask efficiently, effectively, and timely.

• Strong organizational skills and work ethic.

• Customer service experience.

• Love for data.

Physical Requirements

Individuals must be able to sustain specific physical requirements essential to the job. This includes, but is not limited to:

• Standing – duration of up to 6 hours a day
• Sitting/Stationary positions – sedentary position for a duration of up to 6-8 hours a day for consecutive hours/periods.
• Lifting/Push/Pull – up to 50 pounds of equipment, baggage, supplies, and other items used in the job scope using OSHA guidelines, etc.
• Bending/Squatting – have to be able to safely bend or squat to perform the essential functions under the scope of the job.
• Stairs/Steps/Walking/Climbing – must be able to maneuver stairs safely, climb up/down and walk to access work areas.
• Agility/Fine Motor Skills - Must demonstrate agility and fine motor skills to operate and activate equipment, devices, instruments, and tools to complete essential job functions (i.e., typing, use of supplies, equipment, etc.)
• Sight/Visual Requirements – must be able to read documentation, papers, orders, signs, etc., and accurately type/write documentation, etc.
• Audio Hearing and Motor Skills (language) Requirements – must be able to listen attentively and document information from patients, community members, co-workers, clients, providers, etc., and intake information through audio processing with accuracy. In addition, one must be able to speak comfortably and clearly with language and motor skills for customers to understand an individual.
• Cognitive Ability – Must be able to demonstrate good decision-making, reasonableness, cognitive ability, rational processing, and analysis to satisfy essential functions of the job.

Disclaimer: Responsibilities and tasks outlined in this job description are not exhaustive and may change as determined by the needs of the company.

We are an affirmative action and equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, disability, age, sexual orientation, gender identity, national origin, veteran status, height, weight, or genetic information. We are committed to providing access, equal opportunity, and reasonable accommodation for individuals with disabilities in employment, its services, programs, and activities.