Primary City/State:
Arizona, Arizona
Department Name:
Provider Data Management
Work Shift:
Day
Job Category:
Information Technology
A rewarding career that fits your life. As an employer of the future, we are proud to offer our team members many career and lifestyle choices including remote & hybrid work options. If you’re looking to leverage your abilities – you belong at Banner.
Banner Plans & Networks (BPN) is a nationally recognized healthcare leader that integrates Medicare and private health plans. Our main goal is to reduce healthcare costs while keeping our members in optimal health. BPN is known for its innovative, collaborative, and team-oriented approach to healthcare. We offer diverse career opportunities, from entry-level to leadership positions, and extend our innovation to employment settings by including remote and hybrid opportunities.
As a Network Data Specialist for Banner Plans & Networks, you will be part of the Provider Data Management Team. You will call upon your provider management and IDX application experience to enter provider information into Provider Manager for claims payments to be made. Prior work experience in provider network planning, process management, or healthcare operations experience is highly preferred.
Your work location will be entirely remote. Your work shifts will be Monday-Friday working in business hours in the Arizona Time Zone. If this role sounds like the one for you, Apply Today!
Banner Health Network (BHN) is an accountable care organization that joins Arizona's largest health care provider, Banner Health, and an extensive network of primary care and specialty physicians to provide the most comprehensive healthcare solutions for Maricopa County and parts of Pinal County. Through BHN, known nationally as an innovative leader in new health care models, insurance plans and physicians are coming together to work collaboratively to keep members in optimal health, while reducing costs.
POSITION SUMMARY
This position provides file maintenance of the provider database. Ensures accuracy of high volume data and maintenance of provider demographic and contract files. Interprets provider contractual language and interprets guidelines. Maintains proper record keeping of all system support files.
CORE FUNCTIONS
1. Maintains current and validated provider demographics, networks, tax identification, 1099 data, Medicare certification and NPI data in the system with a high level of accuracy and meeting minimum productivity requirements.
2. Provides information to appropriate personnel in regard to changes and updates in system support files.
3. Assist in education of providers, hospitals and the internal and external staff on demographic and network data requirements.
4. Identifies, assists, and resolves managed care issues concerning claims, contract interpretation, eligibility and general provider demographic operational issues.
5. May communicate with network providers and staff and inform them of any operational, procedural, and contractual changes and updates.
6. Assists internal departments in resolving provider and member appeals pertaining to the physician, ancillary providers and hospital network arrangements and plan contracts.
7. Maintains accurate and current provider information and provides system support in provider network development.
8. Assists with reporting network development needs in various geographic regions. Completes managed care contracts updates in the Impact system for payors and providers. Creates and processes required provider statistics and reporting.
9. Assists in the system development and maintenance for a designated comprehensive provider network of physicians and hospitals. Under limited supervision, responds to and resolves issues related to the daily administration of demographic data for potential and existing providers and non-contracted providers. Customers may include Network Providers, Payors, Physicians and internal Provider Relations and Claims Reimbursement team members.
MINIMUM QUALIFICATIONS
Strong knowledge and understanding of healthcare planning as normally demonstrated through a minimum of one year of provider network planning and/or process management or operations experience.
Requires strong Excel knowledge, ability to analyze statistical data, and the ability to work on a variety of projects in an organized fashion. Must possess a strong knowledge of business and/or healthcare as normally obtained through provider relations experience or healthcare provider file maintenance experience.
Must have an understanding of managed care reimbursement strategies and methodologies for physicians, hospitals and ancillary providers. Must be able to communicate effectively with others by speaking, reading, and writing.
PREFERRED QUALIFICATIONS
Bachelor’s degree in business, healthcare administration, or related field. One year of medical claims auditing and or provider data demographic processing experience and an understanding of medical terminology and knowledge of CPT-4 and ICD-9 coding.
Additional related education and/or experience preferred.
EEO Statement:
EEO/Female/Minority/Disability/Veterans
Our organization supports a drug-free work environment.
Privacy Policy:
Privacy Policy
Top Skills
What We Do
Canadian Tire Corporation, Limited (“CTC”) is one of Canada’s most admired and trusted companies. With world-class owned brands and exciting market-leading merchandising strategies, we are continually innovating with purpose: to be there for Canadians from coast-to-coast.
We are a group of companies that includes a retail segment, a financial services division and CT REIT. Our retail business is led by Canadian Tire, which was founded in 1922 and provides Canadians with products for life in Canada across its Living, Playing, Fixing, Automotive and Seasonal & Gardening categories. Party City, PartSource and Gas+ are key parts of the Canadian Tire network. Our retail segment also includes Mark's, a leading source for casual and industrial wear, Pro Hockey Life, a hockey speciality store catering to elite athletes, and SportChek, Hockey Experts, Sports Experts, and Atmosphere, which offer the best active wear brands. Our 1,700 retail and gasoline outlets are supported and strengthened by our Financial Services division and the tens of thousands of people employed across the country by our Company, local Dealers, franchisees and petroleum retailers. In addition, CTC owns and operates Helly Hansen, a leading technical outdoor brand based in Oslo, Norway.
CTC is an integral part of the communities in which we operate and our legacy of community support, through national and local programs, is initiated and executed by our Corporation, Dealers, franchisees, store operators and employees. Since 2005, our Canadian Tire Jumpstart Charities has been helping kids overcome financial and accessibility barriers to sport and recreation in an effort to provide inclusive play for all kids of all abilities.
For more information, visit corp.canadiantire.ca.
.png)
 (1).png)
