Provider Data Process Specialist

Summary/Position Objectives:

This position reports to the Provider Data Management Supervisor and is responsible for assisting and supporting the Provider Management division in its daily operations and planning specifically the administration of provider services to Maryland Physicians Care, a managed care organization. The incumbent will provide the team with high-level, detail-oriented administrative support to include document inventory, maintaining shared mailboxes, managing fax receipts and distribution, completing, and uploading forms and service tickets, supporting new enrollments, Provider Data Management(PDM) projects and other administrative duties such as serving as the initial contact for the division The incumbent will assist the leadership with the coordination of internal projects and generating reports and branding.

About Maryland Care Management, Inc. (MCMI)

Maryland Care Management, Inc. (MCMI) manages Maryland Physician Care's (MPC) statewide provider network of hospitals and physicians. Maryland Physicians Care has been providing services to the HealthChoice Medicaid populations since 1996, and we are proud of our footprint in the community. With over 230,000 members, MPC consistently has been one of MD's largest Medicaid-managed care organizations.

Why join us?

MCMI recognizes the importance of flexibility and offers multiple work arrangements. Along with competitive pay, we offer excellent benefits (medical, dental, and vision plans, 100% employer Term Life Insurance, Short and Long-Term Disability, 401k Employer Match up to 4%) as well as 20 days of PTO, and tuition assistance/professional development plans.

Your future colleagues at MCMI are welcoming, friendly, and eager to help each other succeed. We are committed to Diversity, Equity, and Inclusion, providing organizational-wide social opportunities, and constantly improving our ongoing efforts to positively impact our members' lives.

What You'll Do:

• Completes and uploads provider enrollment and credentialing forms.
• Manages and supports the provider roster.
• Manages all Provider Data Management work queues and reconciliation reports
• Processes demographic changes through ticketing system.
• Processes joining participating group provider requests.
• Manages Provider Credentialing Approval letter logging process.
• Manages and supports provider email and fax blast announcements.
• Maintains shared mailbox for Provider Relations to include assigning and logging (site audits, appeals & grievances referrals and new provider orientations).
• Maintains inventory for provider handouts, reorders when appropriate.
• Manages provider relations monthly supply pickup.
• Provide education to providers and internal business partners on PDM functions or tasks.
• Serves as subject matter expert (SME) for the department.

Secondary Functions:

• Maintains effective working relationships with various providers, networks, and managed health care component.
• Continues education regarding change and trends in health care management and specific provider communications.

Knowledge and Skills:

• Work requires demonstrated experience with Microsoft Office 365 to include proficient and successful utilization of Word, Excel, Outlook, Teams, and Adobe applications.
• Working knowledge of provider identifiers (TIN, NPI, NPI2) and healthcare data standards.
• Strong problem-solving and the ability to use reason to define problems, collect data, establish fact, draw valid conclusions and design, implement, and manage appropriate action plans.

Education and Work Experience:

• Work requires the skills generally acquired through the completion of a High School diploma or GED.
• 2 years in provider data management, credentialing, enrollment, or healthcare operations.
• Familiarity with provider data systems, ticketing systems, and document management tools
• Strongly preferred 1 year of provider/claims experience

EEOC Statement:

Following applicable federal, state, and local laws, MCMI prohibits discrimination in employment based on race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), national origin, age, disability, genetic information, or any other characteristic protected by law. This commitment extends to all aspects of employment, including hiring, promotion, compensation, benefits, training, social and recreational programs, and all other conditions and privileges of employment.

As a healthcare organization, we recognize the vital importance of inclusivity in delivering quality care to our patients. We strive to foster an environment where individuals of all backgrounds feel respected, valued, and supported. We aim to better comprehend the unique needs of our patients and provide healthcare services that are culturally competent and sensitive.

We encourage candidates from all backgrounds to apply and join us in our mission to provide compassionate and inclusive healthcare. We believe that a diverse workforce enriches our organization and allows us to better understand, connect with, and serve our diverse patient population.