Provider Data Management and Contract Load Professional
About the position
Humana is seeking a Provider Data Management and Contract Load Professional to support the Wisconsin Medicaid market. This position is crucial in maintaining the integrity and accuracy of provider data within the Provider Data Management System (PDMS). The role involves performing data maintenance and supporting various functions within the Wisconsin Medicaid Market across all lines of business, including Medicare DSNP, Medicaid, and Long Term Care. The professional will be responsible for ensuring that all provider updates, such as additions, changes, and deletions, are researched, analyzed, and completed accurately and in a timely manner. The Provider Data Management and Contract Load Professional will create provider records in the PDMS from received applications and maintain standards for database integrity and quality assurance. This includes outreach to practitioners regarding unreturned applications and updating practitioner rosters for delegated credentialing agreements. The role also involves generating recredentialing applications and conducting follow-ups with organizational providers on unreturned applications. Additionally, the professional will enter provider demographic information for Prior Authorization requests within the PDMS and provide feedback to reduce errors and improve processes and performance. Collaboration with other departments is essential for database improvements and updates, and participation in the preparation required for regulatory and internal reporting and the Provider Directory is expected. The professional will represent the department in pertinent internal committees and meetings, maintain and respond to department email inboxes, and generate monthly monitoring reports identifying licensure and certification renewals. The role may also involve assisting with ad hoc projects as needed.
Responsibilities
Maintain accurate and up-to-date provider data in the Provider Data Management System (PDMS).
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Collaborate with staff to ensure all provider updates (adds, changes, deletes) are researched, analyzed, and completed accurately and timely.
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Create provider records in the PDMS from received applications.
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Maintain standards for database integrity and quality assurance.
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Outreach to practitioners on unreturned applications.
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Update practitioner rosters within PDMS for delegated credentialing agreements.
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Generate recredentialing applications and follow up with organizational providers on unreturned applications.
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Enter provider demographic information for Prior Authorization requests within the PDMS.
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Provide feedback to reduce errors and improve processes and performance; coordinate corrective activities.
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Work collaboratively with other departments regarding database improvements and updates.
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Participate in preparation for regulatory and internal reporting and the Provider Directory.
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Represent the department on pertinent internal committees and meetings.
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Maintain and respond to department email inboxes.
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Generate monthly monitoring reports identifying licensure and certification renewals and perform outreach to providers and organizations ensuring renewals.
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Assist with ad hoc projects.
Requirements
Associate degree and 1 or more years of experience in a business or health care environment working with provider files or the collection and coordination of practitioner data OR 2 years of the same experience.
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Proficiency with computer software programs such as Microsoft Excel and Word, and ability to understand and learn new information systems and software programs.
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Experience interacting effectively with healthcare providers.
Nice-to-haves
Prior work experience and knowledge of Long Term Care, Medical, Behavioral Health, and Ancillary providers.
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Bachelor's degree.
Benefits
Health benefits effective day 1
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Paid time off, holidays, volunteer time and jury duty pay
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Recognition pay
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401(k) retirement savings plan with employer match
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Tuition assistance
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Scholarships for eligible dependents
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Parental and caregiver leave
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Employee charity matching program
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Network Resource Groups (NRGs)
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Career development opportunities
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