Location: Portland, Oregon
The Provider Data Management Specialist 2 will perform the end-to-end processes necessary to ensure the contract and demographic data required to implement and operationalize external provider contracts is accurately captured in source systems. Accountable for collection, analysis, validation, and set up of contract data elements, provider information, and practitioner demographics to support contracting, claims payment, credentialing, referrals, regulatory and network adequacy reporting, and directory display. Performs outreach needed to ensure all contracted provider data is accurately maintained within the defined business rules, data quality standards and regulatory timelines. The accuracy and timeliness of securing and maintaining provider contract demographic information in KP's source systems is critically important in order for KP to comply with requirements of Federal and State regulators, employer groups who purchase KP health insurance products for their employees, Members/consumers to have transparency to those providers available to them in KP's networks, and to ensure claims can be processed accurately and timely in accordance with applicable contract terms.
This is a hybrid position that is a blend of working both remotely and in office. Must reside in the Northwest Service Region (Oregon or Washington).
Join Our Medical Group
Northwest Permanente is a self-governed, physician-led, multi-specialty group of 1,500 physicians, surgeons, and clinicians, caring for 630,000 members in Oregon and Southwest Washington. Kaiser Permanente is one of the nation's pre-eminent health care systems, a benchmark for comprehensive, integrated, value-based, and high-quality care.
Major Responsibilities / Essential Functions
- Builds and maintains effective partnerships with contracted practitioners, provider groups, hospital and facility organizations to research and collect required data elements needed to implement provider contracts. Position accountable for maintaining provider demographic and contract data for complex health system and large medical group practices
- Interpret, organize, capture and setup contract data, provider information and practitioner demographics into source systems within defined business rules and data architecture
- Performs contract and data analysis to ensure provider demographic data is correctly configured into systems
- Validates data elements submitted by provider on verification websites to meet data integrity standards
- Works closely with Quality Resource Management Department to initiate credentialing and organizational assessments
- Proactively reaches out and engages contracted providers to ensure timely receipt and accurate processing of provider data updates including processing practitioner roster additions, terminations and practice location changes, updated W9s, pay to locations, ownership changes
- Receives, documents, and ensures timely response to provider inquires; phone calls, emails, related to provider data and practitioner demographics
- Applies knowledge of requirements from federal and state regulator including network adequacy and directory reporting
- Develop and maintains high level of data integrity and quality assurance standards
- Displays analytical and problem-solving skills to research and resolve data discrepancies and data integrity issues within required timeframe
- Collaborates between external provider representatives, and internal stakeholders including Provider Contract Managers, National Claims. Administration, Quality Resource Management, Referral Center and Network Adequacy Program to respond to inquiries related to provider data
- Creates, researches, extracts and analyzes ad hoc reports to monitor data quality and support inquiries from business units and stakeholders
- Participates in data reconciliation and remediation projects necessary to ensure contracted provider data and practitioner demographic data integrity
- Assists in data integrity audits and provides feedback to reduce errors and improve processes and performance
- Supports a variety of priority contracting project responsibilities, as assigned by leadership. Examples include researching and evaluating potential providers available to meet care delivery requirements in market expansion areas
- Develop and maintain systematic workflows and policies & procedures that support accurate and timely provider data management.
- Performs general administrative tasks to support contracting and provider data management needs
- May help mentor and train Provider Data Specialist 1 FTE
- Associate degree or two (2) years experience in data entry, data processing, or data analytics
Minimum Work Experience
- Minimum five (5) years of experience processing contracted provider demographic data within a managed care organization applying knowledge and experience to ensure information is accurately captured and maintained to allow for critical downstream functions (claims processing, network adequacy reporting and directory processes)
- Proficiency with computer software programs such as MS Excel, MS Word, MS Access to organize and communicate information. Ability to quickly learn new information systems and software program
- Must possess strong analytical and problem-solving skills
- Thorough knowledge and experience with multiple data collection techniques and data quality control
- Excellent written and verbal communication skills
- Attention to detail and excellent organizational skills
- Ability to prioritize and manage multiple tasks and competing priorities
- Strong customer service-oriented focus
- Knowledge of relevant laws, regulatory and accreditation requirements and standards
- Strong interpersonal skills, establishing rapport and working collaboratively with others
- Familiarity with managed care contracting; ability to interpret contract language and key provisions to ensure data received and maintained in source systems is in accordance with the scope and intent of the contract
Equal Opportunity Employer
At Northwest Permanente, we are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants without regard to race, color, religion, sex, pregnancy (including childbirth, lactation, and related medical conditions), national origin, age, physical and mental disability, marital status, sexual orientation, gender identity, gender expression, genetic information (including characteristics and testing), military and veteran status, and any other characteristic protected by applicable law. Northwest Permanente believes that equity, inclusion, and diversity among our employees are critical to our success, and we seek to recruit, develop, and retain the most talented people from a diverse candidate pool.