The Medicaid COMET (Coordinated Medicaid and Enterprise Transformation Program) - Provider Data Integration seeking dedicated individuals to support data configuration in QNXT in preparation for migration from QNXT to the Enterprise Provider Data Base (EPDB) and to support Medicaid COMET activities. This role will be essential to the successful integration of provider data to improve the quality and accuracy of provider records. This is an Entry Level position.

The Provider Data Specialist is responsible for the maintenance of the provider record (demographic and contractual) for all network and non-network providers and ensures that all provider information is accurately recorded and maintained to provide for proper reimbursement and member access (i.e., directory listings).

Role Responsibilities

• Provides support for baseline provider data transactions that cannot be administered automatically through the provider database due to system limitations and/or data integrity issues.
• Performs baseline demographic transaction updates in provider system applications in support of claim adjudication and Provider directory
• Provides on-going department support in research and analysis essential to resolving concerns/issues raised by providers and other internal/external customers.
• Sends requests to individual providers and/or delegated groups to verify information on file and follows up as needed to ensure information is received.
• Conducts audits of provider information and escalates issues for resolution as appropriate

Pay Range
The typical pay range for this role is:
Minimum: 17.00
Maximum: 27.16

Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.

Required Qualifications

• Demonstrated PC skills, including Microsoft Office products and internet navigation skills.
• Demonstrated success in a production-orientated environment meeting or exceeding production targets.
• Six months data entry experience.

Preferred Qualifications

• Previous industry experience with provider data preferred
• Demonstrated success prioritizing work and the ability to multi-task in a fast-paced environment.

Education

• High School Diploma or G.E.D.

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