Provider Integration Data Specialist

The Provider Integration Data Entry Specialist Enters, supports and maintains provider data from multiple sources for all lines of business in multiple data sources. Processes inquiries from internal and external customers (Providers, Provider Entities, Third Party Administrator Groups, and Employer Groups).  Provides excellent service to internal and external customers through demonstrated commitment to Network Health’s Mission, Values and business operation plans. 

Location: Candidates must reside in the state of Wisconsin for consideration. This position is eligible to work at your home office (reliable internet is required). Travel to the corporate office in Menasha will be required occasionally for the position, including on first day.

Hours: 1.0 FTE, 40 hours per week, 8am-5pm Monday through Friday

Check out our 2024 Community Report to learn a little more about the difference our employees make in the communities we live and work in. As an employee, you will have the opportunity to work hard and have fun while getting paid to volunteer in your local neighborhood. You too, can be part of the team and making a difference. Apply to this position to learn more about our team.

Job Responsibilities: 

• Demonstrate commitment and behavior aligned with the philosophy, mission, values and vision of Network Health
• Appropriately apply all organizational and regulatory principles, procedures, requirements, regulations, and policies
• Ability to multi-task to ensure all provider data is loaded into any/all data sources while meeting audit and regulatory requirements
• Must be able to prioritize work to ensure required daily and ongoing issues are completed within the timeframe requirements of NCQA and CMS
• Research, analyze, and respond to providers’ inquiries, as well as issues raised by internal personnel, providing timely solutions to problems while also handling inquiries with responses communicated verbally or in written format. The work involves the necessity for accuracy, discretion and requires analysis and research of incomplete, conflicting or complex information 
• Responsible for thorough investigation of data discrepancies. This includes good communication, analyzing data, critical thinking and problem solving
• Ensure accuracy of provider data in multiple systems and respond to inquiries timely/accordingly.
• Efficient in the use of multiple software/systems (e.g. QNXT, Echo, QuickBase, Adobe Acrobat, Microsoft Office Word/Excel). Ability to establish a rapport and professionally work with a broad spectrum of internal and external customers, maintaining proper voice tone and language in accordance with the caller's level of understanding and to ensure positive customer perception
• Ability to work as a team member, as well as working with other internal departments, independently demonstrating a high level of initiative and self-direction with limited assistance
• Ensure the protection of NHP/NHI/NH_TPA/NHIC hardware, software, information and data complying with NHP/NHI/NH_TPA/NHIC security requirements and policies
• Ensure the protection of the privacy and confidentiality of data
• Continuously look for process improvement opportunities
• Perform other duties and responsibilities as assigned

Job Requirements:

• High school diploma, or equivalent.
• Associate degree or related experience preferred
• Two or more years experience in the insurance industry.
• At least two years work experience working with data entry, changes and maintenance
• Knowledge of insurance principles.
• Knowledge of databases, word processing and spreadsheet applications (Microsoft Word and Excel).
• Ability to learn software and appropriate standards related to CMS, NCQA.
• PC proficient; data entry skills with a high degree of accuracy.
• Employee is responsible for carrying out daily assignments

Network Health is an Equal Opportunity Employer.