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Provider Informatics Position


Supports and maintains provider data for multiple lines of business (HMO, POS, PPO, Medicare Advantage, Self-Funded) in multiple data sources. Extracts provider data for statistical purposes, PPO claims administration, network adequacy analysis, creation of Provider Directories. Processes telephone inquiries from internal customers (AHS/NHP), and external customers (Providers, Employer Groups, Member, PPO Third Party Administrators). Provides excellent service to internal and external customers through demonstrated commitment to AHS/NHP Mission, Values and business operation plans.

Professionally work with external customers (e.g. TMG Health, PPO TPAs, CMS). This includes responsibility for thorough investigation of discrepancies, analyze, problem solve, ensure accuracy of provider data in multiple systems and respond to inquiries accordingly. Ability to complete data entry of provider information into any/all data sources, meeting audit and regulatory requirements.
Efficient in the use of multiple software/systems (e.g. QNXT, Facets, QuickBase, GeoAccess, Directory/Expert, Adobe Acrobat, Microsoft Office Word/Excel/Access). Ability to program/produce/generate/develop/manipulate reports as necessary. (will train on facility specific software) Will be introduced to internal systems.
Ability to establish a rapport with a broad spectrum of internal and external customers, maintaining proper voice tone and language in accordance with the caller's level of understanding and to ensure positive customer perception.
Produce, publish, send and track all directories, printed and online.
Produce, manipulate, send and track data files for all PPO TPA Provider extracts.
Ability to maintain confidentiality as it relates to providers/contracts.
Ability to work as a team member, as well as working with other internal departments, independently demonstrating a high level of initiative and self-direction with limited assistance.
Ability to write and maintain Processes/Procedure(s) related to provider data.

Skills:
Able to review complex situations/documents.
Independent analysis and decision making
Intermediate to advance skills in MS Excel and Outlook, Word can be beginner to intermediate, about 45 wpm or greater for typing

Minimum Education Required:
High school diploma, or equivalent. Associate degree or related experience preferred.

Minimum Related Years of Experience (per minimum education) Required:
Two or more years' experience in the insurance industry, specific to provider medical. At least two years' work experience working with data entry, changes and maintenance.

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