Network Data Specialist at Banner Health in Remote

Summary: Banner Health is a nationally recognized healthcare leader that integrates Medicare and private health plans. As a Network Data Specialist, you will be responsible for maintaining the provider database, ensuring the accuracy of provider demographic and contract files, and assisting in the education of providers and staff regarding data requirements. Responsibilities: - Maintains current and validated provider demographics, networks, tax identification, 1099 data, Medicare certification and NPI data in the system with a high level of accuracy and meeting minimum productivity requirements - Provides information to appropriate personnel in regard to changes and updates in system support files - Assist in education of providers, hospitals and the internal and external staff on demographic and network data requirements - Identifies, assists, and resolves managed care issues concerning claims, contract interpretation, eligibility and general provider demographic operational issues - May communicate with network providers and staff and inform them of any operational, procedural, and contractual changes and updates - Assists internal departments in resolving provider and member appeals pertaining to the physician, ancillary providers and hospital network arrangements and plan contracts - Maintains accurate and current provider information and provides system support in provider network development - Assists with reporting network development needs in various geographic regions - Completes managed care contracts updates in the Impact system for payors and providers - Creates and processes required provider statistics and reporting - Assists in the system development and maintenance for a designated comprehensive provider network of physicians and hospitals - Under limited supervision, responds to and resolves issues related to the daily administration of demographic data for potential and existing providers and non-contracted providers - Customers may include Network Providers, Payors, Physicians and internal Provider Relations and Claims Reimbursement team members Required Qualifications: - Strong knowledge and understanding of healthcare planning as normally demonstrated through a minimum of one year of provider network planning and/or process management or operations experience - Requires strong Excel knowledge, ability to analyze statistical data, and the ability to work on a variety of projects in an organized fashion - Must possess a strong knowledge of business and/or healthcare as normally obtained through provider relations experience or healthcare provider file maintenance experience - Must have an understanding of managed care reimbursement strategies and methodologies for physicians, hospitals and ancillary providers - Must be able to communicate effectively with others by speaking, reading, and writing Preferred Qualifications: - Bachelor's degree in business, healthcare administration, or related field - One year of medical claims auditing and or provider data demographic processing experience and an understanding of medical terminology and knowledge of CPT-4 and ICD-9 coding - Additional Related Education And/or Experience Preferred Required Skills: Provider network planning, Process management, Healthcare operations, Excel, Statistical data analysis, Provider relations, Healthcare provider file maintenance, Managed care reimbursement, Medical claims auditing, Medical terminology, CPT-4 coding, ICD-9 coding