A Provider Data Specialist takes responsibility for handling data as per the company’s guidelines. Essential roles and responsibilities designated to this role are listed on the Provider Data Specialist Resume as – analyzing and validating data, ensuring data security, storing documents, assisting staff with data entry tasks; submitting data for audits; updating records; coordinating with data vendors, corresponding with multiple client teams; assisting external data vendors; aiding data collection and formulating reports; managing to grant preparation and evaluating expenses; participating in departmental meetings; maintaining confidential records of the facility.
People interested in this job role should demonstrate on the resume the following skills – data analysis and management expertise, computer proficiency; interpersonal skills, communication skills, experience in data extraction and manipulation; huge knowledge of UNIX and secure file transfer technologies; and deep knowledge of MS Office. Successful resumes make a display of a college degree in fields such as information technology.
Objective : Responsible for servicing a defined segment of multiple provider types and or integrated delivery systems with moderate complexity in PA, NJ, MD, And DE and is the single point of contact for all reported issues. Provider types include PCP's, Specialists, Hospitals, Ancillary Providers, and integrated delivery systems.
Skills : Customer Service, Technical Support.
Description :
Arranged set-up for group affiliations, investigate, analyze, and manage routine information on providers in multiple states.
Reviewed and updated provider data sheets and reports returned from providers.
Contacted providers via telephone or in writing to verify data submitted, and enter data into systems.
Provided support to providers, integrated delivery system, Network Coordinators.
Performed payment and other provider-type analysis on an ad hoc basis.
Investigated issues surrounding claims, payments to physicians, quality incentive program, credentialing/re-credentialing, and pricing.
Experience
2-5 Years
Level
Junior
Education
GED
Provider Data Specialist Resume
Headline : A Provider Data Specialist position at a company where I can have opportunities for strong team collaboration, professional growth, and increased responsibility. Industry areas of expertise include the manufacturing, telecom, and healthcare industry, with an emphasis on Common knowledge and familiarity with employment laws and acts such as Title VII, ADA, and FMLA Over 2 years of HR/Recruiting experience.
Skills : Microsoft Office Suite, People Soft HR, ADP HR, HRMS,.
Description :
Performed credentialing and re-credential activities for health plans according to plan specifications.
Created and maintained credentialing files consistent with NCQA standards.
Entered credentialing data into provider data management system and maintain 98% data accuracy.
Ensured compliance with the National Committee for Quality Assurance (NCQA) and the Department of Health and Family Services (DHFS) credentialing requirements.
Completed Prime Secure Verification process.
Developed a spreadsheet used to track the files completed and the time used and managed in order to show and provide substantiating documentation of the workload completed daily since there is currently no system in place.
Processed NQ claims on a daily basis, meeting a required quota, and ensuring that claims do not exceed the 30 day timeline.
Experience
5-7 Years
Level
Executive
Education
MS
Provider Data Specialist Resume
Objective : Responsible for Analyzing provider data for processing Assisted with production of provider directory Processed test scenarios for system development and enhancement.
Skills : Call Center, Collections, Data Entry.
Description :
Reported and extracted data for various reports and analyses, initiating database improvements.
Maintained standards for database integrity and quality assurance.
Maintained the current provider data to ensure the quality of the network Adding and maintaining providers/groups and contracts to the database.
Conducted data entry and re-work; analyzes and identifies trends and provides reports as necessary Research, identify and obtain data/information needed to help process provider/group requests.
Identified and resolved claims processing errors/issues and trends, as needed.
Navigated systems tools, screens, and macros efficiently.
Used appropriate documentation, reference materials, and/or websites to ensure that requests are processed acutely.
Experience
2-5 Years
Level
Executive
Education
GED
Provider Data Specialist Resume
Headline : Seeking a Provider Data Specialist position to utilize my extensive professional experience and abilities in the areas of clerical support, data entry, administrative, and customer service.
Skills : Microsoft Work/office, Multitasking, Planning Skills.
Description :
Maintained and updated provider information within multiple databases; open/closed locations, update contact information, payment information, etc.
Updated claims database to process provides payments.
Generated correspondence letters to providers confirming updates/changes have been made.
Validated/updated provider's Medicare status.
Contacted providers to verify information as needed.
Scanned, uploaded, and verified documents for auditing.
Assisted with training new hires on procedures and working with databases.
Experience
5-7 Years
Level
Junior
Education
BS
Provider Data Specialist Resume
Headline : To obtain a Provider Data Specialist position that will enable me to use my strong organizational background within a professional environment maximizing my potential while assisting the organization in meeting company goals.
Skills : Inventory Management, Business Management, Typing, Microsoft Office, Leadership, Workshop facilitation.
Description :
Provided help to members with the administering of their health benefits and processing of claims.
Performed preliminary research and solve problems systematically using sound business judgment Provide outbound calls to providers and members on billing issues and benefits administration.
Consistently meet established productivity, schedule adherence, and quality standards.
Assisted in team meetings and team progression.
Assisted with the creation of exchange documentation to assist with exchange HA call flow.
Directly serviced calls for dedicated team General Electric and UHC Exchange Provide support for Training Department and served as an On the Job Training Coach Database maintenance, reporting and extracting data for various reports and analyses, initiating database improvement.
Developed and maintained standards for database integrity and quality assurance coordinates corrective activities to clean database and retain users and manages communication processes with other departments regarding database improvements.
Experience
5-7 Years
Level
Executive
Education
BA
Provider Data Specialist Resume
Objective : Participating in full life cycle development by performing requirements analysis, process development and design, and testing using development methodology. Collaborating with functional teams, as well as with IT business analysts and programmers to develop detailed design specifications according to standards.
Skills : Microsoft Excel, Public Speaking, Community Outreach, Accounting, Data Analysis, Public Relations, Data Entry, Social Media, Networking, Collaboration, Team Building,
Description :
Maintained current provider data to ensure the quality of the network.
Contacted doctor offices to verify hospital affiliations.
Updated doctor demographic information through the NDB platform.
Updated information through PVOS database Enter updated demographic information through Phycon database Completes incoming faxes sent from provider offices.
Consistently met and exceed production goals.
Assisted in training and helping new hires with job functions.
Initiated, coordinated, processed, and monitored initial appointment and reappointment credentialing applications.
Experience
2-5 Years
Level
Junior
Education
BS
Provider Data Specialist Resume
Headline : Seeking an entry-level Provider Data Specialist position in an office environment, where there is a need for a variety of office management tasks including-computer knowledge, organizational abilities, business intelligence, and database program use.
Skills : Microsoft Office Programs, Quickbooks Online.
Description :
Responsible for the completion of provider data projects for Independence Blue Cross health care providers in multiple health care networks.
Monitored the accuracy of provider data and approached providers in a tactful manner to identify positive alternative solutions when dealing with complex information.
Demonstrated success and received a 96% accuracy rating when inputting provider information into the computer system.
Received above satisfactory scores when being evaluated by the department quality assurance department that insulated the company from legal risk.
Provided prompt, accurate, and exceptional customer service while enduring positive relationships with health care providers.
Acknowledged and responded to inbound inquiries that related to health care provider issues within Independence Blue Cross.
Developed a strategic planning process to gain relevant knowledge of Independence Blue Cross health care products.
Experience
5-7 Years
Level
Executive
Education
G.E.D
Provider Data Specialist Resume
Summary : Over 20 + years of experience as the Provider Data Specialist; with proven capabilities in customer satisfaction and retention through quality assurance and production efficiencies, offering a demonstrated spirit of teamwork, Training, and working with others to achieve company goals.
Skills : Microsoft Office, Customer Service, Graphic Design, Photoshop.
Description :
Reviewed and revised provider demographic information for Delegate Roster Management Team.
Developed and maintained an inter-departmental calendar that assigned daily tasks and projects on a rotating basis, creating a structure for timely claims processing.
Ran reports for senior management.
Used Excel Spreadsheet to make changes to provider tax identification to new provider group, DEA license information; updated Medicaid number for a provider; provider specialty.
Verified accurate information was recorded into the database.
Reviewed claims for provider demographic information for MAMSI Live and Pend 52.
Added providers to the national database and utilized state board to verify provider license.
Experience
10+ Years
Level
Senior
Education
Diploma
Provider Data Specialist Resume
Objective : Gathering, verifying, and evaluating healthcare provider credentials for initial and re-credentialing applications; identifying potential issues; determining if further investigation or information is necessary and makes appropriate inquiries; assessing completed applications to ensure PeaceHealth criteria are met and all necessary elements are present and correct.
Skills : Microsoft Office, Management Experience, Data Entry, Logistics, Customer Service.
Description :
Structured and billing set up, eligibility collection, database loading, and preparation of plan materials such as administrative documents and provider education materials.
Utilized medical billing and coding software to keep bills and patient profiles up to date with no errors.
Ensured the integrity of the department's metrics and the company itself.
Used Software skills, including but not limited to, Microsoft office.
Utilized customer service skills as well as computer software experience.
Consistently met deadline time frames.
Conducted audits and provided feedback to reduce errors and improve processes and performance.
Experience
2-5 Years
Level
Junior
Education
BS In Business Management
Provider Data Specialist Resume
Objective : Seeking a Provider Data Specialist position in an office environment, where there is a need for a variety of office management tasks including computer knowledge, organizational abilities, business intelligence, and database program use.
Skills : Customer Service, Data Entry, Filing, General Office, Outlook, Problem Solving, Training.
Description :
Performed database maintenance, reporting, and extracting data for various reports and analyses, initiating database improvement.
Developed and maintained standards for database integrity and quality assurance, coordinate corrective activities to clean database and retain users, and manage communication processes with other departments regarding database improvements.
Conducted audits and providing feedback to reduce errors and improve processes and performance, maintaining current provider data to ensure the quality of the network.
Responsible for representing the provider network area on company IT projects, reporting and tracking provider calls and complaints, or for the support, coordination, and production of the paper directory cycle.
Made sure providers' information was correctly displayed in the provider directory so that members can find providers in their area to give them medical care.
Demonstrated great customer service skills when contacting office managers or credentialing managers to verify their demographic information.
Used computer skills in Excel to create spreadsheets to email to the providers so they could update their information writing if they didn't want to do it over the phone.
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