Job Description:
• Execute provider data additions, terminations, and updates
• Perform data remediation in HCPM, CPF, and Facets
• Implement updates identified through quality audits and performance analyses
• Apply contract terms and network business rules
• Identify operational risks and issues during data load processes and take corrective action
• Validate data accuracy across multiple systems and transmission to downstream platforms
• Conduct root cause analysis and implement solutions
• Analyze intake requests from matrix partners and execute provider, network, or criteria-level updates
• Maintain production and quality standards, including timely documentation in the Daily Activity Log
• Support system enhancement initiatives through testing, validation, and checkout activities
• Collaborate with the team while maintaining accountability for individual results
Requirements:
• High school diploma or GED required; some college coursework preferred
• 2+ years of demonstrated proficiency using CPF and HCPM required
• Proclaim and Facets preferred
• Strong understanding of data flow and downstream system impacts
• Knowledge of provider structures, including Practitioners, Groups, Facilities, and Ancillaries required
• Solid understanding of contracts, networks, and applicable Market Guidebook standards highly preferred
• Working knowledge of DAL, Inventory Manager, ETQS, Activity Manager, Provider Manager, Renaissance, and Knowledge Exchange highly preferred
• Must have cable broadband or fiber optic internet service with at least 10Mbps download/5Mbps upload when working from home
Benefits:
• Annual bonus plan eligibility
• Medical, vision, and dental benefits starting on day one
• Well-being and behavioral health programs
• 401(k)
• Company-paid life insurance
• Tuition reimbursement
• Minimum of 18 days of paid time off per year
• Paid holidays
• Leaves of absence
• Work-at-home arrangement
• Cable broadband or fiber optic internet requirement with at least 10Mbps download/5Mbps upload