CareOregon Looking for Provider Data Specialist Lead at Portland, OR  Full Time

To protect the health and well-being of our members, employees and community, CareOregon requires all employees to be fully vaccinated against COVID-19 or have an approved medical or religious exception as a qualification of employment.

Candidates who receive an offer of employment by CareOregon, must provide proof of COVID-19 vaccination or submit a medical or religious exception request, which will be evaluated in accordance with CareOregon’s standard accommodation process.

Position Title: Provider Data Specialist Lead

Department: Enterprise Applications

Title of Manager: Provider and Encounter Data Manager

Supervises: Non-Supervisory Position

Exemption Status: Non-Exempt

Requisition ID: 21924

Job Summary

This position is responsible for lead level product support to provider data within the QNXT module. Primary tasks include provider data maintenance, integrity, and reporting, as well as operational and people leadership assistance. This position drives substantial process improvements that enhance department productivity, turn-around time, and data integrity. It is crucial this position fully understands the upstream and downstream impacts of accurate data loading.

Essential Responsibilities

Provider Database Maintenance

• Perform accurate and timely data entry into provider database, following Provider Data policies and procedures.
• Provide data management and process knowledge to the organization; organize and lead projects.
• Investigate and resolve provider and provider contract pended claims through communication with the Provider Data team, provider offices, assigned Provider Relations Specialist; and Claims department; apply claims policies and procedures.
• Monitor call and email queues by reviewing requests and communicating clearly and timely with contracted provider offices and internal customers; research demographic and affiliations changes; make updates to provider database reflecting current information once validated.
• Manage monthly provider rosters received from contracted hospital systems and IPAs by investigating changes and validating information prior to updating QNXT.
• Complete provider database projects resulting from contracting, configuration, or regulatory changes.
• Sort incoming faxes, PIVs and distribute according to assignments.
• Maintain SharePoint libraries according to department protocols.
• Enroll providers in Oregon Health Plan (OHA) Health Systems using MMIS web enrollment portal.
• Reroute critical pieces of return mail including 1099s, live checks and remittance advice by investigating demographic discrepancies and reflecting changes in QNXT.
• Create and maintain security access for provider web portal; troubleshoot and investigate provider portal issues when they arise.

Provider Database Integrity

• Troubleshoot provider setup to support provider reporting, directory, and claims operation.
• Perform testing of new software versions.
• Identify, develop, and implement reporting and/or processes to ensure adherence to regulatory and compliance requirements and to monitor quality and productivity.
• Conduct audits and analysis in accordance with provider contracts, claims and regulatory requirements while using experience with data extracts, manipulation and/or data management.
• Research internal and external data sets, validate the data and determines the correct course of action in case of data discrepancy/anomalies.
• Conduct analyses of provider-related new and existing product and business unit needs, documenting requirements and revising existing logic, as necessary.

Provider Data Reporting

• Generate and send ad hoc and scheduled reports to business partners and regulatory entities.
• Perform intermediate spreadsheet analyses and database solutions using tools such as Excel and SQL.
• Communicate with internal partners to document data requirements and transform into specifications for development.

Operational Assistance

• Consult with Provider Customer Service, Provider Relations, IS leadership, users, stakeholders, and external vendors to define and document business requirements for reporting provider data.
• Maintain documented variable criteria and logic used to produce provider data reporting, including the provider directory.
• Help monitor provider data table accuracy and serve as a resource to Provider Data Specialists.
• Represent Provider Data in cross-organizational committees and projects.
• Contribute information and ideas toward work processes.

Employee Leadership

• Provide leadership for a team in support of team direction and goals.
• Provide input into staffing needs; assist in recruiting and hiring staff, using an equity, diversity, and inclusion lens.
• Participate in organizing, scheduling, monitoring, and improving work; help ensure employees have information to meet job expectations and have coverage during absences.
• Contribute to the development, communication, and oversight of team and individual goals.
• Train, lead, and coach employees; may facilitate team meetings.
• Incorporate guidance from CareOregon equity tools into people leadership.
• Help monitor employee adherence to department and organizational standards, policies, and procedures.
• Assist in evaluating employee performance, providing feedback to support success, recognizing powerful performance, and addressing performance gaps and accountability (corrective action).
• Perform lead tasks in collaboration with Human Resources as needed.

Organizational Responsibilities

• Perform work in alignment with the organization’s mission, vision, and values.
• Support the organization’s commitment to equity, diversity, and inclusion by fostering a culture of open mindedness, cultural awareness, compassion, and respect for all individuals.
• Strive to meet annual business goals in support the organization’s strategic goals.
• Adhere to the organization’s policies, procedures, and other relevant compliance needs.
• Perform other duties as needed.

Knowledge, Skills and Abilities Required

Technical

• Exceptional knowledge of relational databases
• Exceptional understanding of managed care, Medicare, and Oregon Health Plan concepts, including the ability to train and coach others on this information
• Advanced skills in claims processing technologies, such as QNXT and Facets
• Advanced skills in document management and collaboration platforms, such as SharePoint and Office 365
• Advanced skills with Microsoft Office Suite products, especially Excel
• Ability to participate in the development and monitoring of policies and procedures in performing job responsibilities
• Advanced skills troubleshooting data integrity issues and root cause
• Expert ability to author and maintain process documentation

Communication

• Effective communication skills, including listening, verbal, written, and customer service; ability to facilitate meetings and presentations
• Ability to clearly articulate policies, instructions, goals, and objectives
• Able to convey appropriate level of detail effectively to all levels of the organization including non-technical staff and executive leadership
• Proactively and appropriately communicates status and needs

Other

• Advanced ability to manage multiple and competing priorities and requests
• Possess a high degree of initiative and motivation
• Ability to effectively collaborate with coworkers, staff, leaders, and executives across all departments
• Excellent attention to detail and deadlines
• Able to see the big picture beyond a request and take appropriate holistic action, employing “systems thinking”
• Strong organizational skills
• Ability to prioritize own and others’ work based on business need and direction
• Proficient analytical and strong research skills; able to see patterns in data and draw appropriate conclusions
• Ability to maintain a cheerful outlook
• Understands and adheres to governance and process
• Able to propose solutions and communicate business value
• Strong leadership skills, including the ability to mentor and coach developing junior staff

Physical Skills and Abilities

Lifting/Carrying up to 0 Pounds Pushing/Pulling up to 0 Pounds Pinching/Retrieving Small Objects Crouching/Crawling Reaching Climbing Stairs Repetitive Finger/Wrist/Elbow/ Shoulder/Neck Movement

0 hours/day 0 hours/day 0 hours/day 0 hours/day 0 hours/day 0 hours/day More than 6 hours/day

Standing Walking Sitting Bending Seeing Reading Hearing Speaking Clearly

0 hours/day 0 hours/day 0 hours/day 0 hours/day More than 6 hours/day More than 6 hours/day 3-6 hours/day 3-6 hours/day

Cognitive and Other Skills and Abilities

Ability to focus on and comprehend information, learn new skills and abilities, assess a situation, and seek or determine appropriate resolution, accept managerial direction, and feedback, and tolerate and manage stress.

Education and/or Experience

Required:

• Minimum 3 years’ experience, including 2 years as a Provider Data Specialist III (or equivalent external experience)

Preferred:

• Experience with people and/or project leadership

Working Conditions

• Environment: This position’s primary responsibilities typically take place in the following environment(s) (check all that apply on a regular basis):

Inside/office Clinics/health facilities Member homes

Other_________________________________________

• Travel: This position may include occasional required or optional travel outside of the workplace, in which the employee’s personal vehicle, local transit, or other means of transportation may be used.
• Equipment: General office equipment
• Hazards: n/a

Candidates of color are strongly encouraged to apply. CareOregon is committed to building a linguistically and culturally diverse and inclusive work environment

Veterans are strongly encouraged to apply.

Equal opportunity employer. This company considers all candidates regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.