• Provider Systems Data Specialist I

    Job Locations US-CA-Fairfield
    Job ID
    Provider Relations
  • Overview

    To maintain accurate provider information by entering all necessary data elements into several database systems. Reviews forms for completeness and researches discrepancies. Ensures all information is updated timely within departmental standards. Responds to routine provider telephone inquiries via telephone and email.


    • Reviews forms for completion and researches and resolves routine discrepancies.
    • Enters and maintains accurate provider demographic information into database systems.
    • Interacts with providers by telephone to obtain information necessary to maintain updated records.
    • Monitors the Help Desk and responds to or disseminates inquiries to appropriate staff for resolution.
    • Responds to routine telephone inquiries using an ACD telephone system.
    • Recommends updates to procedures and improvements to processes.
    • Prepares documents, logs, and reports using Microsoft Word and Excel.
    • Files both paper and scanned documents.
    • Other duties as assigned.


    Education and Experience

    High school diploma or equivalent; 2 years of data entry experience, preferably in a managed care environment in the areas of provider data elements or claims. Working knowledge of provider NPI, Tax ID, Taxonomy, or Specialty terminology preferred.



    Special Skills, Licenses and Certifications

    Advanced computer skills, including proficiency in multiple software applications including Microsoft Office. Familiarity with database applications. Strong organizational and multi-tasking skills. Detail oriented with ability to recognize vital information. Excellent interpersonal and customer service skills.




    Performance Based Competencies

    Ability to consistently maintain production and timeliness standards.




    Work Environment And Physical Demands

    More than 70% of work time is spent using a computer. When required, the ability to lift, carry, or move objects of varying size, weighing up to 25 lbs. Must be able to work in a fast paced environment and maintain courtesy and composure. Ability to function




    All HealthPlan employees are expected to:

    • Provide the highest possible level of service to clients;
    • Promote teamwork and cooperative effort among employees;
    • Maintain safe practices; and
    • Abide by the HealthPlan’s policies and procedures, as they may from time to time be updated.




    The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive or definitive of the tasks that an employee may be required to perform.  The employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change.


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