Senior Provider Integration Data Entry Specialist

The Senior Provider Integration Data Specialist will provide excellent service to internal and external customers through demonstrated commitment to Network Health Mission, Values, and business operation plan. Responsibilities include oversight, maintenance, and support of provider data for all lines of business in multiple data sources; processing telephone inquiries from internal and external stakeholders; extraction of provider data for statistical purposes, claims administration, network adequacy analysis; and creation of Provider Directories.

Location: Candidates must reside in the state of Wisconsin for consideration. This position is eligible to work at your home office (reliable internet is required). Occasional travel to the Menasha office may be required, including on first day.

Hours: 1.0 FTE, 40 hours per week, 8am-5pm Monday through Friday

Check out our 2024 Annual Report video to learn a little more about the difference our employees make in the communities we live and work in. As an employee, you will have the opportunity to work hard and have fun while getting paid to volunteer in your local neighborhood. You too, can be part of the team and making a difference. Apply to this position to learn more about our team.

Job Responsibilities:

• Assist Provider Integration leadership with projects, reports and tasks
• Audit Provider Integration data entry tasks
• Create and provide updates to the Provider Integration Departmental Procedures.
• Receive, interpret, and accurately/timely respond to inquiries from Provider Integration representatives, providers, and internal and external customers. The work involves the necessity for accuracy, discretion, and requires analysis and research of incomplete, conflicting, or complex information.
• Ability to establish a rapport and professionally work 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
• Extract provider data for statistical, claims processing, and network adequacy purposes
• Ability to program, develop, produce, and manipulate provider data reports as necessary
• Train new and existing staff
• Produce, publish, and accurately maintain Network Health Provider directories for all lines of business
• Identify and evaluate opportunities to enhance department efficiencies as well as continuously looks for process improvement opportunities
• Receive, interpret, and accurately work with data loads from providers
• Ability to multi-task to ensure all provider data is loaded into any/all data sources while meeting audit and regulatory requirements.
• Must be able to prioritize work to ensure required daily and ongoing issues are completed within the timeframe requirements of NCQA and CMS.
• Interact professionally and effectively with providers, management, and other departments
• Adhere to departmental policies and comply with applicable regulations
• Demonstrate an organized and accountable approach to daily administrative responsibilities
• May participate on projects, workgroups, and committees, as appropriate
• Research, analyze, and respond to providers' inquiries, as well as issues raised by internal personnel, providing timely solutions to problems while also handling inquiries with responses communicated verbally or in written format.
• Responsible for thorough investigation of data discrepancies. This includes good communication, analyzing data, critical thinking and problem solving.
• Ensure accuracy of provider data in multiple systems and respond to inquiries timely/accordingly
• 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
• Ensure the protection of hardware, software, information, and data; complying with security requirements and policies

Job Requirements:

• High school diploma, or equivalent required
• Associate degree or related experience preferred
• Three years or more experience in the insurance industry, customer service experience required
• At least three years work experience working with data entry, changes, and maintenance required

Network Health is an Equal Opportunity Employer