Provider Data Specialist I

• Provide product support for provider data within the QNXT module
• Add, maintain, and update provider data records
• Assist with database integrity and configure provider data and contract information using written guidelines
• Perform accurate and timely data entry following Provider Data policies and procedures
• Provide data management and process knowledge and assist with projects
• Investigate and resolve provider and provider contract pending claims
• Monitor call and email queues and communicate with contracted provider offices and internal customers
• Research demographic and affiliation changes and update the provider database after validation
• Manage monthly provider rosters from contracted hospital systems and IPAs
• Complete provider database projects resulting from contracting, configuration, or regulatory changes
• Sort incoming faxes and PIVs and distribute them according to assignments
• Maintain SharePoint libraries
• Enroll providers with OHA Health Systems using the MMIS web enrollment portal
• Reroute critical return mail, including 1099s, live checks, and remittance advice
• Troubleshoot provider portal issues
• Troubleshoot provider setup supporting reporting, directories, and claims operations
• Test new software versions
• Validate data through license boards, IRS, NPPES, and other third-party verification
• Resolve data errors through troubleshooter processes and internal audits

Requirements

• Minimum 1 year of experience with data configuration, data management, credentialing, or claims management
• Familiarity with relational databases
• General understanding of or ability to learn managed care and Oregon Health Plan concepts
• Familiarity with Microsoft Office Suite products, especially Excel
• Ability to learn and effectively navigate claims processing technologies such as QNXT and Facets
• Ability to learn and effectively navigate document management and collaboration platforms such as SharePoint and Office 365
• Ability to follow policies and procedures
• Ability to troubleshoot data integrity issues and identify root causes
• Ability to author and maintain process documentation
• Proficient listening, verbal, written, and customer service communication skills
• Ability to articulate instructions and communicate effectively with non-technical staff
• Ability to handle multiple priorities and requests
• Attention to detail and deadlines
• Ability to develop analytical and research skills
• Ability to work effectively with diverse individuals and groups
• Ability to see, read, and perform repetitive finger and wrist movement for at least 6 hours/day
• Ability to hear and speak clearly for at least 3–6 hours/day

Core Competencies

Demonstrates expertise in data management and configuration, with a strong focus on provider data integrity and compliance with policies and procedures. Proficient in utilizing relational databases and collaboration tools to support claims processing and provider enrollment.

Highest-signal resume keywords

• Data Management
• Provider Data Configuration
• Claims Management
• Relational Database Familiarity
• Microsoft Office Suite Proficiency

Hard Skills

• Data Configuration
• Data Management
• Credentialing
• Claims Management
• Database Integrity
• Data Entry
• Process Documentation
• Troubleshooting
• Analytical Skills
• Research Skills

Soft Skills

• Customer Service Communication
• Attention to Detail
• Ability to Handle Multiple Priorities
• Effective Communication
• Listening Skills

Industry Keywords

• Managed Care
• Oregon Health Plan
• Provider Data Policies
• Regulatory Changes
• Provider Enrollment

Tools & Technologies

• QNXT
• Facets
• SharePoint
• Office 365
• MMIS Web Enrollment Portal