Health Plans Provider Data Management Coordinator

Overview

As a patient-focused organization, University of Utah Health exists to enhance the health and well-being of people through patient care, research and education. Success in this mission requires a culture of collaboration, excellence, leadership, and respect. University of Utah Health seeks staff that are committed to the values of compassion, collaboration, innovation, responsibility, integrity, quality and trust that are integral to our mission. EO/AA

This position for use in Health Plans Departments only. The Provider Data Management Coordinator plays a crucial role in ensuring and maintaining the integrity of the provider and vendor data as it relates to provider records. This individual works closely with both internal and external parties on all aspects of provider data. They are responsible for provider data management activities related to data entry, data analysis, quality assurance planning, client/vendor relations, and continuous improvement of data collection, mapping, analysis, and transformation. The individual who fills this position will need to be able to work well in a cross-functional organization and be able to be both responsive to needs and thoughtful and directive in supporting and implementing UUHP''s products.This position is not responsible for providing care to patients.

Corporate Overview: University of Utah Health is an integrated academic healthcare system with five hospitals including a level 1 trauma center, eleven community health centers, over 1,600 providers, and a health plan serving over 200,000 members. University of Utah Health is nationally ranked and recognized for our academic research, quality standards and overall patient experience. In addition to our clinical delivery system, we have a School of Medicine, School of Dentistry, College of Nursing, College of Pharmacy, and College of Health providing education and training for over 1,250 providers annually. We have over 2 million patient visits annually and research grants exceeding $350 million. University of Utah Hospitals and Clinics represents our clinical operations for the larger health system.

Responsibilities

Essential Functions

• Researches, reviews and completes all complexity levels of provider record creation and maintenance to ensure accuracy in the Provider Data Management system.
• Coordinates corrective action plans with clients and third party vendors to resolve data discrepancies and issues.
• Assists in the development and implementation of standard Provider Data Management operational processes.
• Manages the end-to-end Provider Data Management process to ensure providers are set up correctly for provider directory display, member assignment, claims payment, and other downstream systems/processes.
• Develops, maintains standards, and ensures integrity for healthcare provider data.
• Assists in the design of data management system, quality audits and continuous improvement initiatives to increase data accuracy.
• Assists with defining data quality checks at appropriate stages to ensure all data meets requirements for operations, analytics and reporting.
• Oversees content publication of provider directories for all assigned lines of business.
• Acts as the subject matter expert for provider related data. Provides training where needed.
• Networks and builds professional relationships with key stakeholders both internal and external to UUHP.
• Implements provider relations'' activities that support company goals, objectives and strategies.
• Coordinates with multiple departments to ensure Provider Data Management updates and policies are effectively communicated and implemented.
• Functions as a point-of-contact for escalated billing and policy or service issues as needed by providers, Operations and Care Management; develops and implements solutions that are beneficial to providers, UUHP customers, and the overall objectives of UUHP.
• Coordinates and prepares data for imports and exports.
• Work claims pools for Provider Set up and payment accuracy.

Knowledge / Skills / Abilities

• Highly detail oriented with strong analytical and problem solving abilities, particularly with the flow and integration of data systems, and root cause analysis.
• Strong oral and written communication skills to effectively communicate with a broad array of internal and external contacts.
• Strong research, follow-up, documentation and issue resolution skills.
• Proven ability to build and maintain positive relationships with large and complex market-leading institutional and professional providers.
• Knowledge and understanding of the provider community and principles of healthcare delivery systems.
• Self-motivated with effective time management skills.
• Proficient with word processing, spreadsheet, database, internet and e-mail applications.
• Committed to transforming the way health care is delivered.

Qualifications

Required

• Bachelor''s Degree in healthcare, business or related field or equivalency.
• Two years'' experience in the healthcare industry with specific focus in provider or payer relations, provider or payer contracting, customer service, or financial analysis.

Qualifications (Preferred)

Preferred

• Healthcare or provider data operations experience.
• Healthcare information management knowledge in some combination of Provider or payer organizations.
• Experience with healthcare data entry, analysis, and reporting.
• Experience around defining and documenting business processes and rules.
• Track record of cross-functional performance in delivery of requirements analysis activities, i.e., interfacing with operations, systems/IT.
• Medical claims experience.

Working Conditions and Physical Demands

Employee must be able to meet the following requirements with or without an accommodation.

• This is a sedentary position in an office setting that may exert up to 10 pounds and may lift, carry, push, pull or otherwise move objects. This position involves sitting most of the time and is not exposed to adverse environmental conditions.

Physical Requirements

Listening, Sitting, Speaking