Provider Data Specialist

Location: Orange, California US

Notice

This position is no longer open.

Job Number: 4238

Position Title: Provider Data Specialist

External Description:

Position Summary:

The Provider Data Specialist will maintain the data integrity of Alignment Healthcare’s (AHC) provider database. The Provider Data Specialist will perform data entry of all types of contracted providers, practitioners and facilities, and maintain data integrity as directed by the Provider Data Management Supervisor/Manager.

General Duties/Responsibilities:

Essential duties and responsibilities includes, but are not limited to:

  • Enter provider demographic information into AHC’s provider database, as well as any updates necessary to existing provider’s demographic records, including but not limited to issuing of termination date information to a provider’s demographic record.
  • Assure the accuracy of the provider information in Alignment’s provider database.
  • Process Change of Information (CIF) request as they come in electronically via “ProviderData” mailbox in accordance with the timeline set forth by the department’s Policy and Procedure.
  • Conduct large volume system provider upload and/or termination as necessary.
  • Assist Report Analyst with the production, and timely filing of all provider directories by ensuring that all directories are accurate in content. Assist in placing calls as necessary to providers to verify demographic information.
  • Process assigned monthly reconciliation report related to data integrity projects.
  • Monitor compliance of contracted medical groups’ adherence to AHC’s provider profile requirements and with CMS required specialty types.
  • Test AHC’s provider database as necessary and assist with any system integrations related to provider database.
  • General customer service both internally and externally related to provider inquiries and network status.
  • Maintenance of an accurate and complete filing system, including electronic filing system (CIFs, contracts), to track demographic information loaded to AHC’s database and ensuring the security of both hard copy and scanned files.

Supervisory Responsibilities:

This job has no supervisory responsibilities.

Minimum Requirements:

  1. Minimum Experience:
    1. 1-2 years’ experience in provider services, healthcare services or IT as clerk
  2. Education/Licensure:
    1. High School diploma or general education degree (GED)
    2. No license, certification required
  3. Language Skills: Ability to read and interpret documents such as safety rules, operating and maintenance instructions and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of the organization.
  4. Reasoning Skills: Ability to apply common sense understanding to carry out detailed but uninvolved written or oral instructions. Ability to deal with problems involving a few concrete variables in standardized situations.
  5. Other:
    1. Basic computer skills required
    2. Proficiency in Microsoft applications a must
    3. Data entry minimum of 45 wpm
    4. Analytical and problem solving is a plus
    5. Medical terminology, and Healthcare coding familiarity is a plus, but not required
    6. Excellent organization and clerical skills


Essential Physical Functions:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

  • While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel and talk or hear.
  • The employee is frequently required to reach with hands and arms.
  • The employee is occasionally required to stand; walk; climb or balance and stoop, kneel, crouch, or crawl.
  • The employee must occasionally lift and/or move up to 10 to15 pounds.
  • Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.

Working Environment

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

City: Orange

State: California

Location City: Orange

Location State: California

Community / Marketing Title: Provider Data Specialist

Company Profile:

Alignment Health was founded with a mission to revolutionize health care with a serving heart culture. Through its unique integrated care delivery models, deep physician partnerships and use of proprietary technologies, Alignment is committed to transforming health care one person at a time.

By becoming a part of the Alignment Health team, you will provide members with the quality of care they truly need and deserve. We believe that great work comes from people who are inspired to be their best. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment community.

EEO Employer Verbiage:

Alignment requires all new hires to follow local and/or state requirements regarding the COVID-19 vaccine and booster.  If applicable, proof of vaccination and booster will be required as a condition of employment subject to legal exemptions.  This policy, which Alignment reserves the right to modify, is part of Alignment’s ongoing efforts to ensure the safety and well-being of its staff and community and to support public health efforts.

Alignment Healthcare, LLC is proud to practice Equal Employment Opportunity and Affirmative Action. We are looking for diversity in qualified candidates for employment: Minority/Female/Disable/Protected Veteran.

If you require any reasonable accommodation under the Americans with Disabilities Act (ADA) in completing the online application, interviewing, completing any pre-employment testing or otherwise participating in the employee selection process, please contact [email protected].

*DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health’s talent acquisition team, please email [email protected].