Provider Data Analyst Inspired by faith. Driven by innovation. Powered by humankindness. CommonSpirit Health is building a healthier future for all through its integrated health services. As one of the nation's largest nonprofit Catholic healthcare organizations, CommonSpirit Health delivers more than 20 million patient encounters annually through more than 2,300 clinics, care sites and 158 hospital-based locations, in addition to its home-based services and virtual care offerings. As our Provider Data Analyst, you will maintain DHMSO's provider data network in QNXT. Every day you will create and update provider records, work with Contracting and Credentialing on questions, and partner with Configuration, Claims, and Enrollment so claims are paid accurately and on time. To be successful in this role, you will bring provider data management experience, QNXT or similar system knowledge, and meticulous accuracy. As a remote employee, we will provide you with the equipment needed to work from home, including a laptop, docking station, dual monitors, and accessories. While this position can reside anywhere in the US, working PST business hours will be expected. Works on provider Load template - understand all the data elements that must be completed to load the providers and work any that error out. Maintains and updates Monthly Rosters for multiple participating groups. Troubleshoots provider load configuration issues based on testing results. Maintains the Provider Data (demographic and contractual) for all network and non-network providers. Ensures all provider information is accurately recorded and maintained to provide for proper reimbursement and member access (i.e., directory listings).Develops and maintains standards for database integrity, database alignment, and manages communication processes with other departments regarding database improvements.
Required:- Bachelor's degree or equivalent experience
- Minimum of 3 (three) years experience managing provider data and working in QNXTProven ability to work with other business functions
- Working knowledge of DHPR and CMS rules for Claim Submission, Claim Payment, Eligibility Appeals for Commercial, MediCare and MediCal lines of business
- One Community. One Mission.
- One California
Depending on the position offered, CommonSpirit Health offers a generous benefit package, including but not limited to medical, prescription drug, dental, vision plans, life insurance, paid time off (full-time benefit eligible team members may receive a minimum of 14 paid time off days, including holidays annually), tuition reimbursement, retirement plan benefit(s) including, but not limited to, 401(k), 403(b), and other defined benefits offerings, as may be amended from time to time. For more information, please visit our Total Rewards.