Randstad Provider Database Analyst in Campbell, California
Provider Database Analyst
Tuesday, October 4, 2016
GENERAL DESCRIPTION OF POSITION
The Provider Database Analyst independently reviews, evaluates, and maintains the integrity of the databases that support all provider contracts, provider reporting, medical service authorizations, payments of claims, and member assignment in all core systems. Works under the direction of the Manager, Provider Database and Reporting.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Independently ensure all contracts, provider demographics, and claims information is entered in the core system, and maintain the integrity of provider data on an ongoing basis for all applicable business needs. To perform this job successfully, an individual must be able to perform each essential duty listed below satisfactorily.
1.Oversee daily analysis, data configuration, maintenance, and procedures to ensure validity of data received through provider contracts, delegated entities, and non-contracted claims.
2.Oversee all data entry activities in core systems and utilize SQL validation reports to ensure that the most competent methods are followed.
3.Produce accurate, complete, and dependable data and reports to meet strict compliance turn-around times.
4.Perform data validation and create monthly provider directories, internal reconciliation reports, and regulatory compliance reports.
5.Identify, analyze, and report provider database issues.
6.Work collaboratively with IS to test and troubleshoot provider data.
7.Examine pending claims and update or correct provider data to assist with claims adjudication.
8.Train staff, document desktop procedures, and create flow charts applicable to departmental functions.
9.Perform any other related duties as required or assigned
REQUIREMENTS - Required (R) Desired (D)
The requirements listed below are representative of the knowledge, skill, and/or ability required or desired.
1.Bachelor s Degree in Computer Science, Business Administration, or Health Administration. (R)
2.Minimum three years of experience in a managed care environment with an emphasis on provider relations, provider database management, claims pricing and auditing or configuration.. (R)
Knowledge of relational databases such as SQL and Microsoft Access. (R)
Knowledge of Microsoft Office Suite. (R)
Knowledge of CPT, HPCP, Rev and ICD codes used for medical claims billing. (D)
Knowledge of provider contracts, fee schedules, and reimbursement methodologies including Medi-Cal and Medicare guidelines. (D)
7.Strong verbal and written communication skills. (R)