Healthcare Data Support Specialist – Managed Care
New York, NY (Manhattan, Financial District)
** This is a Full Time, Benefits Available, CONTRACT opportunity, expected to last 5 months or more! **
Data Specialist Job Summary:
Data Specialist Background:
- The Healthcare Data Specialist plays an integral part in the maintenance of accurate databases and reports in order to monitor network compliance with federal and state requirements.
- Responsible for providing data entry and data management support within the health plan, as it relates to the contracted provider network and federal and state requirements.
- Create and maintain multiple databases, including:
- contracted provider network
- prior authorization
- third party liability
- provider set ups and related corrections
- Oversee the provider termination process including adding and changing new or existing provider records in the medical information system
- Schedule monthly provider verifications regarding provider enrollment specifications and demographic changes
- Update delegated provider Medicare and Medicaid documents on a monthly and ad hoc basis and ensure state compliance
- Provide appropriate reports and statistical data to other department designees for review, follow-up and resolution
- Requires an education level of at least a high school diploma or GED; Associate’s degree is a plus.
- Strong data entry skills required.
- At least 1 year experience in a medical office, hospital or health plan call center, or other healthcare support role with heavy computer & database use.
- 1-3 years experience in claims processing, provider, or credentialing preferred.
- Strongly prefer 1 or more years at a Managed Care Organization (Health Plan, IPA/Medical Group, HMO, TPA/MSO, etc).
- Requires basic to intermediary familiarity with Medical terminology (1-3 years direct experience).
- Basic knowledge of health care delivery systems, Managed Care Organizations as well as Medicaid/Medicare and related state programs is needed.
- Proficient in Microsoft Office applications, with demonstrable skills in Access and Excel, and the ability to learn new and complex computer system applications.
- Previous experience with database management, data reporting, and data analysis preferred.
- Must have a minimum of 30 wpm typing with a high level of accuracy.