Analyze, research, and input relevant data for providers added to the organization’s network through individual contracts, facility/ancillary contracts and/or newly acquired group contracts. Maintain changes to current provider files including provider terminations. Provider records to be updated include but are not limited to practitioner, facility, ancillary, and group records.

Obtain missing data and update provider profiles specific to provider directory and/or client data extracts.

Research and respond to all ad hoc requests (status checks) from both internal and external customers. Fully update provider profiles as appropriate while assuring continual adherence to established operational guidelines.

Identify issues that require additional investigation and evaluation, validate discrepancies incurred and ensure appropriate follow up. Refer complex issues to management for appropriate disposition.

Complete special projects as assigned by management. This may include but is not limited to both telephonic and electronic investigative work. Verify, research, and respond to telephone inquiries and written inquiries from providers and other departments pertaining to provider participation in a professional and courteous manner.

Partner cross-functionally as necessary to ensure accurate and efficient disposition of data investigations and maintenance work.

Ensure systematic data-oriented efforts to improve consumer and/or client services. One hundred percent (100%) of this job is related to QM activities.

Collaborate, coordinate, and communicate across disciplines and departments.

Ensure compliance with HIPAA regulations and requirements.

Demonstrate Company’s Core Competencies and values held within.

The position responsibilities outlined above are in no way to be construed as all encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned as necessary.