Provider Data Management Auditor

POSITION SUMMARY/RESPONSIBILITIES

The Data Management Auditor will be responsible for the development and maintenance of the Data Management auditing program for all lines of business offered by Community First Health Plans to improve provider configuration standards.  This position requires knowledge of all provider configuration aspects related to adding new providers, terming existing providers, and maintenance of existing and updated provider data in the core QNXT system.  Ensures provider configuration is based on incoming requests received from Network Management, Population Health Management, and daily pending claims inventory.  This position will also be responsible for building and testing provider case scenarios as new provider module system enhancements are made or when new business products are launched.  The Data Management Auditor will work closely with the Data Management Manager, Coordinators, Plan Reimbursement staff, and all Configuration Specialists to ensure provider information and contracts are added accurately in the core provider module to ensure accuracy in claim processing and provider directories.  The Data Management Auditor will abide by all organizational departmental policies, set personal standards, and strives for high quality work in completing assignments, perform job duties in a timely manner, and represent the organization in a positive manner.

EDUCATION/EXPERIENCE

High School diploma or equivalency is required.  Minimum of (5) years’ experience in health insurance environment or similar.  Previous experience in training and provider relations preferred.  Supervisory experience preferred.