Network Data Specialist
Job DescriptionInnovative, Dynamic, Fast Pace and Collaborative, these are just some of the words that our employees use to describe us but hey - don’t just take it from us - become a part of BroadPath today and experience our Culture of Constant Connection! At BroadPath we strive to transform the modern workplace by embracing the spirit of revolution coupled with advanced technology to create an experience out of every day. BroadPath is excited to be hiring a Network Data Specialist. This WAH position provides administrative support to various projects inclusive of updating provider database and/or credentialing requirements. Ensures accuracy of high-volume data and maintenance of provider demographic and contract files. Interprets provider contractual language and interprets guidelines. Maintains proper record keeping of all system support files.
- Maintains current and validated provider demographics, networks, tax identification, 1099 data, Medicare certification and NPI data in the system with a high level of accuracy and meeting minimum productivity requirements.
- Provides information to appropriate personnel regarding changes and updates in system support files.
- Assist in education of providers, hospitals and the internal and external staff on demographic and network data requirements.
- Identifies, assists, and resolves managed care issues concerning claims, contract interpretation, eligibility and general provider demographic operational issues (aka credentialing)
- May communicate with network providers and staff and inform them of any operational, procedural, and contractual changes and updates.
- Assists internal departments in resolving provider and member appeals pertaining to the physician, ancillary providers and hospital network arrangements and plan contracts.
- Maintains accurate and current provider information and provides system support in provider network development.
- Assists with reporting network development needs in various geographic regions. Completes managed care contracts updates in the Impact system for payors and providers. Creates and processes required provider statistics and reporting.
- May be tasked with assisting with credentialing to ensure that physicians and healthcare facilities are in compliance with relevant regulations. They may also keep records related to insurance contracts and staff credentials. They often must keep in contact with staff and insurance companies to ensure that they have all the necessary documents and inform them of any changes in contracts and policies.
Basic Qualificationso Strong knowledge and understanding of healthcare planning as normally demonstrated through a minimum of one year of provider network planning and/or process management or operations experience.
o Must understand managed care reimbursement strategies and methodologies for physicians, hospitals, and ancillary providers. Must be able to communicate effectively with others by speaking, reading, and writing.
Detail-oriented, organized decision-maker with the ability to work both independently and in teams. Strong oral and written communication skills are also essential, as these specialists spend a lot of time communicating with doctors, healthcare administrators, higher education institutions and government officials.
Preferred Qualificationso Bachelor’s degree in business, healthcare administration, or related field.
o One year of medical claims auditing and or provider data demographic processing experience and an understanding of medical terminology and knowledge of CPT-4 and ICD-9 coding.
o Additional related education and/or experience preferred.