Job Description

Where You’ll Work

The purpose of Dignity Health Management Services Organization (Dignity Health MSO) is to build a system-wide integrated physician-centric, full-service management service organization structure. We offer a menu of management and business services that will leverage economies of scale across provider types and geographies and will lead the effort in developing Dignity Health's Medicaid population health care management pathways. Dignity Health MSO is dedicated to providing quality managed care administrative and clinical services to medical groups, hospitals, health plans and employers with a business objective to excel in coordinating patient care in a manner that supports containing costs while continually improving quality of care and levels of service. Dignity Health MSO accomplishes this by capitalizing on industry-leading technology and integrated administrative systems powered by local human resources that put patient care first.

One Community. One Mission. One California

Job Summary and Responsibilities

As our Provider Data Analyst, you will maintain DHMSO's provider data network in QNXT.Every day you will create and update provider records, work with Contracting and Credentialing on questions, and partner with Configuration, Claims, and Enrollment so claims are paid accurately and on time.To be successful in this role, you will bring provider data management experience, QNXT or similar system knowledge, and meticulous accuracy.

As a remote employee, we will provide you with the equipment needed to work from home, including a laptop, docking station, dual monitors, and accessories.

While this position can reside anywhere in the US, working PST business hours will be expected.

• Works on provider Load template - understand all the data elements that must be completed to load the providers and work any that error out.
• Maintains and updates Monthly Rosters for multiple participating groups.
• Troubleshoots provider load configuration issues based on testing results.
• Maintains the Provider Data (demographic and contractual) for all network and non-network providers.
• Ensures all provider information is accurately recorded and maintained to provide for proper reimbursement and member access (i.e., directory listings).
• Develops and maintains standards for database integrity, database alignment, and manages communication processes with other departments regarding database improvements.

Job Requirements

Required:

• Bachelor's degree or equivalent experience
• Minimum of 3 (three) years experience managing provider data and working in QNXT

• Proven ability to work with other business functions

• Working knowledge of DHPR and CMS rules for Claim

• Submission, Claim Payment, Eligibility

• Appeals for Commercial, MediCare and MediCal lines of business

Job Tags

Similar Jobs