Provider Data Management Specialist

As our Provider Data Management Specialist, you will provide data management support services to Dignity Health's CI/ACO Networks, Employer Relations and Valued Based Operations (VBO).

Every day you will gather and maintain accurate provider data, perform periodic provider data reconciliations with multiple data sources, including 3rd party payers, generate reporting on the provider network, conduct review of network adequacy and capabilities, maintain and transmit fee schedules as necessary to third-party administrators (TPA's) and other appropriate stakeholders, and provide customer support services to Dignity Health CI/ACO Networks and VBO's team. You will also support network development to ensure the integrity, accuracy, and completeness of provider information across internal systems, enabling efficient operations, compliance, and network performance. This role is foundational to the success of network optimization efforts in each of the national Value-Hub markets.

To be successful in this role, you will have a deep understanding of provider data, strong attention to detail skills, and the ability to collaborate with internal and extenal stakeholders.

As a remote employee, we will provide you with the equipment needed to work from home, including a laptop, docking station, dual monitors, and accessories.

While this position can reside anywhere in the US, working PST business hours will be expected.

• Responsible for maintaining current, accurate information in all provider database environments by conducting periodic provider data audits and processing demographic change requests received from internal and external sources through the Salesforce application (case object). Including researching various public databases (Secretary of State, specialty Board Cert, Fictitious Business Name, State Medical Board, NPI registry etc.). Enter, update, and validate provider demographics and practice information across databases and systems (CAQH, NPPES, OMA, claims, etc.). Manage NPI, TIN, taxonomy specialties, practice locations, and affiliations on regular cadence to ensure accurate data for network analytics.
• Runs regular reports on provider data to ensure ongoing accuracy, and reconciles and corrects discrepancies as necessary. In addition, conducts monthly provider data comparisons with other Dignity Health systems (cactus, etc.). Audit provider records regularly for accuracy and completeness. Flag, resolve, and document issues related to duplicative records, inactive providers, outdated data, and other discrepancies found within network analytics tools such as Quest Analytics, OMA dashboards, etc. Maintain alignment of provider data across tools used in network analytics, (Excel, Power BI, Google Docs, Cactus). Ensure data completeness for analysis of referral patterns, patient access, utilization and cost of care.
• Publishes monthly (and otherwise as needed) provider directories for internal and external use. Collaborate with network development leadership on special projects involving network expansion, gap analysis, and specialty coverage. Prepares and maintains all network provider data for easy and accessible tracking. Document network development standard operations procedures and support audit preparations for any future Medicare Advantage, Medicaid, and commercial payer partner arrangements. Support analysis of national provider networks to ensure high utilization opportunities and risks.
• Supports regular communication about demographic and contract status changes (add/delete reports) with internal and external stakeholders, including payors.
• Conducts periodic review of network adequacy and capabilities.
• Provides departmental telephone support, serving as the initial point of contact for provider calls directed to the Clinical Integration Networks. Conducts necessary research for response or identifies appropriate contact for transfer of calls.

Required

• Three (3) years experience in provider relations, provider credentialing, provider database maintenance and reporting, provider contracting and/or network development in a health care or managed care setting
• High school diploma or GED
• Demonstrated skills in the areas of written and verbal communication, judgment, and problem-solving
• Strong proficiency in Microsoft Office products
• Exceptional customer service, relationship management and interpersonal skills
• Attention to detail
• Capable of independent thinking, as well as perform in a team environment

Preferred

• Bachelors degree in Business, Finance, Health Care Management, Economics preferred
• Experience with member data preferred
• Experience with Catcus, MDStaff or Salesforce preferred

The purpose of Dignity Health Management Services Organization (Dignity Health MSO) is to build a system-wide integrated physician-centric, full-service management service organization structure. We offer a menu of management and business services that will leverage economies of scale across provider types and geographies and will lead the effort in developing Dignity Health's Medicaid population health care management pathways. Dignity Health MSO is dedicated to providing quality managed care administrative and clinical services to medical groups, hospitals, health plans and employers with a business objective to excel in coordinating patient care in a manner that supports containing costs while continually improving quality of care and levels of service. Dignity Health MSO accomplishes this by capitalizing on industry-leading technology and integrated administrative systems powered by local human resources that put patient care first.

One Community. One Mission. One California 

Depending on the position offered, CommonSpirit Health offers a generous benefit package, including but not limited to medical, prescription drug, dental, vision plans, life insurance, paid time off (full-time benefit eligible team members may receive a minimum of 14 paid time off days, including holidays annually), tuition reimbursement, retirement plan benefit(s) including, but not limited to, 401(k), 403(b), and other defined benefits offerings, as may be amended from time to time. For more information, please visit our Total Rewards.

Unless directed by a Collective Bargaining Agreement, applications for this position will be considered on a rolling basis. CommonSpirit Health cannot anticipate the date by which a successful candidate may be identified.