Provider Data Management Analyst I
Posted on: 12 Sep 2021
Chesterfield, MO
Job Description
Position Purpose:
Perform provider data management related activities based on plan and contract specifications and standard business rules – includes data analysis and entry, review of data via internet sites and other systems, and usage of multiple systems and applications to validate data is complete and accurate.
Enroll providers and practitioners into the provider data management system
Update provider and practitioners with claims payment and directory information
Research, review, and make updates within the provider data management system per provider requests
Perform quality service checks on systemic data, inclusive of claims processing and provider directory information
Perform research and resolve problems as necessary
Education/Experience:
Associate’s degree, or high school diploma/equivalent and 1+ years of data entry, analysis or customer service experience, preferably with healthcare operations (i.e. claims processing, billing, provider relations or contracting), provider data management, or credentialing in a managed care, insurance, or medical office environment. Experience performing data analysis in Excel or similar tools strongly preferred.
WellCare
Tampa, FL
WellCare Health Plans, Inc. provides government-sponsored managed care services. The company operates in three segments: Medicaid Health Plans, Medicare Health Plans, and Medicare Prescription Drug Plans (PDPs). The Medicaid Health Plans segment offers plans for beneficiaries of temporary assistance for needy families, supplemental security income, and aged blind and disabled residents; and other state-based programs, such as children's health insurance programs and long-term services and supports programs for qualifying families who are not eligible for Medicaid.
The Medicare Health Plans segment provides Medicare, a federal program that provides eligible persons aged 65 and over, as well as some disabled persons with a range of hospital, medical, and prescription drug benefits; Medicare Advantage, a Medicare’s managed care alternative to the original Medicare program, which offers individuals standard Medicare benefits directly through Centers for Medicare & Medicaid Services; and coordinated care plans that are administered through health maintenance organizations and require members to seek health care services and select a primary care physician from a network of health care providers.
The Medicare PDPs segment provides Medicare part D PDP plans to Medicare-eligible beneficiaries. Its PDP plans offer national in-network prescription drug coverage, including a preferred pharmacy network. As of December 31, 2018, the company served approximately 5.5 million members in the United States. WellCare Health Plans, Inc. was founded in 1985 and is headquartered in Tampa, Florida.
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IndustryHealthcare
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No. of Employees12, 000
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Website
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Jobs Posted917
