Provider Data Specialist I

We need to output HTML fragment with headings

for sections: About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule. Only include sections that have real specific content. We must not repeat job title. Must not include Job ID etc. Must preserve all substantive info, not invent or summarize away detail. Remove boilerplate: cookie/navigation/legal/EEO/equal-opportunity/scam-warning boilerplate, duplicated lines, application instructions. Also remove "Current CareOregon Employees: Please use the internal Workday site to submit an application for this job." Also remove EEO statements. Also remove "We are an equal opportunity employer ..." etc. Also remove "Please contact your recruiter for more information." Also remove "Work Environment(s): ..." maybe we can keep schedule and working conditions? The instruction says include sections only when posting has real specific content. We have Pay: "Estimated Hiring Range $23.28 - $28.45 Bonus Target Bonus - SIP Target, 5% Annual". That's pay info. Schedule: "Work Location: Work from home Schedule: Monday - Friday, 8:00 AM - 5:00 PM". So schedule section. Benefits: "We offer a strong Total Rewards Program. This includes competitive pay, bonus opportunity, and a comprehensive benefits package. Eligibility for bonuses and benefits is dependent on factors such as the position type and the number of scheduled weekly hours. Benefits-eligible employees qualify for benefits beginning on the first of the month on or after their start date. CareOregon offers medical, dental, vision, life, AD&D, and disability insurance, as well as health savings account, flexible spending account(s), lifestyle spending account, employee assistance program, wellness program, discounts, and multiple supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, 529 College Savings, etc.). We also offer a strong retirement plan with employer contributions. Benefits-eligible employees accrue PTO and Paid State Sick Time based on hours worked/scheduled hours and the primary work state. Employees may also receive paid holidays, volunteer time, jury duty, bereavement leave, and more, depending on eligibility. Non-benefits eligible employees can enjoy 401(k) contributions, Paid State Sick Time, wellness and employee assistance program benefits, and other perks." That's benefits content. So include Benefits section. About the role: The first paragraph: "This position is responsible for providing product support to provider data within the QNXT module. Primary tasks include adding, maintaining, and updating provider data records, as well as assistance with database integrity. Correctly configure provider data and contract information using written guidelines. Accurate and timely provider data plays a critical role in the success of claims payment, OHA Health Systems (DMAP) and CMS encounter data submission, PCP assignment, authorization processing, credentialing, IRS reporting, regulatory projects, and the provider directory." That's about the role. Responsibilities: The "Essential Responsibilities" block with subheadings Provider Database Maintenance and Provider Database Integrity. We can combine into a list under Responsibilities. Must use

• for any list of duties/requirements/benefits. So we need to extract each duty as list items. Must preserve all substantive info; not summarize away detail. So we need to list each bullet point from the responsibilities. Let's parse: Provider Database Maintenance: - Perform accurate and timely data entry into provider database, following Provider Data policies and procedures. - Provide data management and process knowledge to the organization; assist with projects. - Investigate and resolve provider and provider contract pending claims as requested by more advanced Provider Data staff; apply claims policies and procedures. - Monitor call and email queues by reviewing requests and communicating clearly and timely with contracted provider offices and internal customers; research demographic and affiliations changes; make updates to provider database reflecting new information once validated. - Manage monthly provider rosters received from contracted hospital systems and IPAs by investigating changes and validating information prior to updating QNXT; consult with advanced Provider Data staff to clarify information. - Complete provider database projects resulting from contracting, configuration, or regulatory changes. - Sort incoming faxes, PIVs and distribute according to assignments. - Maintain SharePoint libraries according to unit protocols. - Enroll providers with OHA Health Systems using MMIS web enrollment portal. - Reroute critical pieces of return mail including 1099s, live checks and remittance advice by investigating demographic discrepancies and reflecting changes in QNXT. - Troubleshoot and investigate provider portal issues when they arise. Provider Database Integrity: - Troubleshoot provider setup to support provider reporting, directory, and claims operation. - Perform testing of new software versions. - Data validation through license boards, IRS, NPPES, and other third-party verification. - Resolve data errors through troubleshooter processes and internal audits. We need to output these as
• items under a
  inside a section with heading

  Responsibilities

  . Requirements: The posting has "Required Experience and/or Education" and "Preferred". Also "Knowledge, Skills And Abilities Required Knowledge" etc. We need to separate sections: Requirements (maybe experience/education), Qualifications (maybe preferred?), Skills (knowledge, skills and abilities). The instruction says use headings for: About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule. So we need to map content accordingly. We have: - Required Experience and/or Education: Minimum 1 year of experience with data configuration, data management, credentialing, or claims management. Preferred 2 years of experience working in health care/insurance. Experience with managed care and/or project participation. That could go under Requirements (maybe required) and Qualifications (preferred). But we need to decide. We also have "Knowledge, Skills And Abilities Required Knowledge" and then list of knowledge items, then "Skills And Abilities" list. That seems like Skills section. Thus: Requirements: Minimum 1 year of experience with data configuration, data management, credentialing, or claims management. Qualifications: Preferred 2 years of experience working in health care/insurance; Experience with managed care and/or project participation. Skills: Knowledge items (Familiarity with relational databases, General understanding of or ability to learn managed care and Oregon Health Plan concepts, Familiarity with Microsoft Office Suite products, especially Excel) plus Skills And Abilities list (many items). We need to preserve all substantive info, not summarize away detail. So we need to list each item as
  • under Skills. We must not create sections with filler like "commensurate with experience". We have actual content. Pay: we have Estimated Hiring Range $23.28 - $28.45 Bonus Target Bonus - SIP Target, 5% Annual. That's specific. So include Pay section. Schedule: Work Location: Work from home Schedule: Monday - Friday, 8:00 AM - 5:00 PM. So include Schedule section. Benefits: as above. Now we must not include boilerplate like EEO, application instructions, etc. Also remove duplicated lines. Ensure we don't include "Work Environment(s): ..." maybe we could include under Schedule? But schedule section already has schedule and location. The work environment details (Indoor/Office etc) maybe not needed; but we could include as part of Schedule? The instruction says include section only when posting has real specific content. The work environment is specific but not under headings we have; we could incorporate into Schedule or maybe omit as not required headings. Since we have no heading for Work Environment, we could drop it. It's not required to preserve all info? The instruction says "Preserve ALL substantive information; do NOT invent or summarize away detail." That suggests we must keep all substantive info, but we can only output under allowed headings. If we drop work environment, we lose substantive info. However we could incorporate it into Schedule section as additional details. The schedule section currently includes schedule and location; we could add work environment details there. That would preserve it. Similarly, we might have "Equipment: General office equipment Travel: May include occasional required or optional travel outside of the workplace; the employee’s personal vehicle, local transit or other means of transportation may be used". That's also substantive. Could add to Schedule or maybe a separate section? Not in headings list. Could add to Schedule as well. We need to decide: The instruction says "Use

    for section headings (e.g. About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule)." It gives examples but not exclusive? It says "Use

    for section headings (e.g. About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule)." Likely they expect only those headings. So we must fit all substantive info into those sections. We can add extra paragraphs under those sections. Thus we can put Work Environment, Equipment, Travel under Schedule section as additional

    paragraphs. Now we need to ensure we don't repeat job title. Not include any headings like "Job ID". Good. Now produce HTML fragment. Structure:

    About the role

    ... (the about role paragraph)

    Responsibilities

    • ...
    ...

    Requirements

    Minimum 1 year of experience with data configuration, data management, credentialing, or claims management.

    Qualifications

    Preferred 2 years of experience working in health care/insurance; Experience with managed care and/or project participation.

    Skills

    • Familiarity with relational databases
    • General understanding of or ability to learn managed care and Oregon Health Plan concepts
    • Familiarity with Microsoft Office Suite products, especially Excel
    • Ability to learn and effectively navigate claims processing technologies, such as QNXT and Facets
    • Ability to learn and effectively navigate document management and collaboration platforms, such as SharePoint and Office 365
    • Ability to follow policies and procedures in performing job responsibilities
    • Ability to develop skills around troubleshooting data integrity issues and root cause
    • Ability to learn how to author and maintain process documentation
    • Proficient communication skills, including listening, verbal, written, and customer service
    • Ability to articulate instructions
    • Learning to convey appropriate level of detail effectively to multiple levels of the organization including non-technical staff
    • Ability to learn to appropriately communicate status and needs
    • General ability to learn to handle multiple priorities and requests
    • Demonstrates general initiative and motivation
    • Ability to effectively collaborate with coworkers
    • Attention to details and deadlines
    • Ability to learn to see the big picture
    • Developing organizational skills
    • Ability to prioritize work based on direction
    • Ability to develop analytical and research skills
    • Ability to maintain a positive attitude
    • Ability to learn governance and process
    • Ability to work effectively with diverse individuals and groups
    • Ability to learn, focus, understand, and evaluate information and determine appropriate actions
    • Ability to accept direction and feedback, as well as tolerate and manage stress
    • Ability to see, read, and perform repetitive finger and wrist movement for at least 6 hours/day
    • Ability to hear and speak clearly for at least 3-6 hours/day

    Benefits

    We offer a strong Total Rewards Program. This includes competitive pay, bonus opportunity, and a comprehensive benefits package. Eligibility for bonuses and benefits is dependent on factors such as the position type and the number of scheduled weekly hours. Benefits-eligible employees qualify for benefits beginning on