Data Integrity Specialist

Responsibilities:

·         Work closely with Manager of Data Integrity in managing provider data integrity initiatives.

·         Fully responsible for verifying and validating provider demographic data across all Funds internal systems for accuracy, completeness, and consistency according to data quality established standards and procedures.

·         Coordinate inter-office efforts required and perform additional duties and projects as assigned by management and required by the No Surprise Act (NSA) including but not limited to delegated entity submissions, initial credentialing, recredentialing, provider correspondence, including conducting independent audit validation and error report reviews from Data Management and Integrity units.

·         Submit any changes to Data Management unit to update provider records profile in the appropriate provider system(s) including but not limited to participating, non-participating, and external network providers and facilities. 

·         Assess inquiries submitted by providers or Fund’s staff thoroughly and compare to existing provider data in provider systems (i.e., Q-NXT, Cactus, DMS).

·         Identify and report to management of any high-level systemic trends and/or system issues that interrupts the system flow or adversely affects data integrity.

·         Monitor and identify provider set-up to ensure ongoing data integrity and compliance with data quality standards.

·         Identify, communicate, address and correct errors, discrepancies and inconsistencies through data cleaning and validation processes.

·         Facilitate, interact, and communicate with internal staff, and providers/representatives to troubleshoot and resolve demographic issues.

·         Correspond with providers via email, telephone, and written correspondence.

·         Special projects: work closely with internal departments at the Funds to ensure data quality is being adhered according to data quality standards and guidelines.

·         Identify and recommend solutions based on data quality standards, procedures, and polices to ensure data validation and integrity is reliable.

·         Resolve and troubleshoot complex provider data discrepancies and report data quality compliance issues.

·         Perform additional duties and projects as assigned by management.

Qualifications:

·         High School Diploma required; Bachelor’s degree preferred

·         Minimum of three (3) years healthcare relevant experience with data management or data quality and experience including quality oversight and provider outreach required.

·         Minimum of three (3) years of customer service skills, conducting telephonic or electronic outreach required.

·         Knowledge of healthcare management systems (i.e., QNXT, Cactus and DMS) and healthcare terminology, preferred

·         Able to work with web-based systems: including proficient in basic skill level with Microsoft Word, Excel, Outlook, and Internet Research preferred.

·         Demonstrate organizational skills with the ability to multi-task and prioritize tasks. Meet departmental goals and operational deadlines

·         Positive work attitude and good interpersonal skills a must; able to maintain professional ethics in the performance of duties.

·         Excellent interpersonal skills: ability to maintain productive work relationships internally and externally.

·         Excellent written and oral communication skills: effective customer service skills.

·         Demonstrate good problem-solving and critical thinking skills.  Able to identify anomalies, trends, inconsistencies and make recommendations to improve processes, and workflows.

·         Ability to excel both independently and collaboratively as a team member