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PROVIDER DATA OPERATIONS SPECIALIST

Cook County Health and Hospitals
COMPETITIVE SALARY
United States, Illinois, Chicago
1969 Ogden Avenue (Show on map)
Nov 22, 2024
Job Posting : Nov 21, 2024, 9:03:19 PM Closing Date : Dec 6, 2024, 5:59:00 AM Full-time Shift Start Time : 8:30 A.M. Shift End Time : 4:30 P.M. Collective Bargaining Unit : None Posting Salary : COMPETITIVE SALARY Organization : Health and Hospital Systems PROVIDER DATA OPERATIONS SPECIALIST MANAGED CARE 8:30AM-4:30PM Job Summary The Provider Data Operations Specialist facilitates all provider data upload files for the Health Plan Services health plan. Performs various analysis and interpretation to link business needs and objectives for assigned functions. Ensures provider data and provider directory is complete and accurate. Monitors, reconciles, and evaluates provider data to ensure data integrity across all Health Plan Services Systems. This position is exempt from Career Service under the CCH Personnel Rules. Typical Duties Maintains provider data though rosters and Share Point. Processes Medicaid and Medicare rosters from provider and facilities. Processes contracts via JIRA for mapping and pricing. Distinguishes between contract labels and rates Medicaid, Medicare, and Exchange. Produces and audits provider directories for multiple medical groups adding terming locations. Identifies discrepancies with practitioner data and information. Maintains medical group demographic information using Vida Pro, NPESS and IObserver. Calls credentialing departments to verify provider information such as specialty and service location information. Verifies if provider is active or terminated on state file. Produces member move forms when providers term affiliation before the end of each month. Sends weekly data information to Claim Payers accordingly. Reviews and audits provider directories. Audits and configures new and existing provider/hospital/ancillary contracts supporting Health Plan Services. Maintains existing provider/hospital/ancillary demographic information ensuring provider data is maintained according to contractual requirements. Reviews provider applications, applies policy and criteria, processes files through and forward to appropriate area for systems loading. Ensures that all provider contract data is accurate and complete to facilitate the data upload of supporting contractual reimbursement expectations. Validates participation in the State's Medical Assistance Program for new and existing providers. Creates reports and conducts data analysis. Manages distribution of internal reports related to network. Remains current with contract updates and explains contractual relationships as needed. Provides training, mentoring and guidance to new staff members. Completes special projects as assigned or directed. Performs other duties as assigned * * Minimum Qualifications High School Diploma or GED is required Three (3) years of provider data management, credentialing or healthcare operations (i.e. claims processing, billing, provider relations, or contracting) experience within a Managed Care Organization is required One (1) year of experience in Managed Care Organization network administration or operations is required Proficiency using Microsoft Office: Word, PowerPoint, and Excel (pivot and vlook up) (May be required to test for proficiency) is required Knowledge, Skills, Abilities and Other Characteristics Excellent verbal and written communication skills necessary to communicate with all levels of staff and a patient population composed of diverse cultures and age groups. Demonstrate analytical and organizational, problem-solving, critical thinking, and conflict management/resolution skills Demonstrate attention to detail, accuracy and precision Ability to prioritize, plan and organize projects and tasks Ability to navigate complex health plan enterprise systems. Ability to work autonomously and as a team member in a multidisciplinary team. VETERAN PREFERENCE PLEASE READ When applying for employment with the Cook County Health & Hospitals System, preference is given to honorably discharged Veterans who have served in the Armed Forces of the United States for not less than 6 months of continuous service. To take advantage of this preference a Veteran must: Meet the minimum qualifications for the position. Identify self as a Veteran on the employment application by answering yes to the question by answering yes to the question, "Are you a Military Veteran?" Attach a copy of their DD 214, DD 215 or NGB 22 (Notice of Separation at time of application filing. Please note: If you have multiple DD214s, 215s, or NGB 22S, Please submit the one with the latest date. Coast Guard must submit a certified copy of the military separation from either the Department of Transportation (Before 9/11) or the Department of Homeland Security (After 9/11). Discharge papers must list and Honorable Discharge Status. Discharge papers not listing an Honorable Discharge Status are not acceptable OR A copy of a valid State ID Card or Driver's License which identifies the holder of the ID as a Veteran, may also be attached to the application at time of filing. If items are not attached, you will not be eligible for Veteran Preference VETERANS MUST PROVIDE ORIGINAL APPLICABLE DISCHARGE PAPERS OR APPLICABLE STATE ID CARD OR DRIVER'S LICENSE AT TIME OF INTERVIEW. Degrees awarded outside of the United States with the exception of those awarded in one of the United States' territories and Canada must be credentialed by an approved U.S. credential evaluation service belonging to the National Association of Credential Evaluation Services (NACES) or the Association of International Credential Evaluators (AICE). Original credentialing documents must be presented at time of interview. Please note all offers of Employment are contingent upon the following conditions: satisfactory professional & employment references, healthcare and criminal background checks, appropriate licensure/certifications and the successful completion of a physical and pre-employment drug screen. CCHHS is strictly prohibited from conditioning, basing or knowingly prejudicing or affecting any term or aspect of County employment or hiring upon or because of any political reason or factor. *COOK COUNTY GOVERNMENT IS AN EQUAL OPPORTUNITY EMPLOYER*