Provider Data Specialist - Health Care Reimbursement
Fallon Community Health Plan - Worcester, MA

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About Fallon Community Health Plan:

Founded in 1977, Fallon Community Health Plan is a nationally recognized, not-for-profit health care services organization. From traditional health insurance products available throughout Massachusetts for all populations, to innovative health care programs and services for independent seniors, FCHP supports the diverse and changing needs of all those it serves. FCHP has consistently ranked among the nation’s top health plans, and is the only health plan in Massachusetts to have been awarded “Excellent” Accreditation by the National Committee for Quality Assurance for its HMO, Medicare Advantage and Medicaid products. For more information, visit fchp.org.

Position Overview:

Responsible for timely and accurate entry of standard provider information into QNXT system and other related databases.

Responsibilities
  • Data entry of standard provider information into QNXT system and other related databases according to established departmental standards for accuracy and timeliness. Complete requests for data entry and reporting according to Internal FCHP Database User Community requirements and expectations.
  • Review Provider data for Plan and coding accuracy prior to entry to database.
  • Research any misleading or missing data fields and escalate any unresolved issues to Manager.
  • Generate weekly status reports for manager’s review of statistical data and trends in the volume of new, updated and outstanding entries. Create ad hoc reports as requested.
  • Participate in research and testing of system application accuracy to resolve processing problems.

Qualifications

Education: HS Diploma or equivalent required. AS Preferred

Experience: 2 years experience in an office environment

Exposure to Health Care Administration preferred

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