Data Entry, Provider Relations

About Us

Community Health Plan was established in 1992 by a network of community health centers across Washington State. We provide coverage for people in 33 counties (see our clinic site list). Our members receive services from more than 1,000 primary care providers and 8,000 specialists at more than 250 primary care sites and over 80 hospitals. We're the fifth-largest health program in Washington (commercial or non-profit).

Key Relationships

Reports To: Regional Manager, Provider Relations

Supervises: Non-Supervisory Position
Other Key Relationships: Credentialing Specialists, Provider Relations Coordinators, Credentialing Delegated Oversight Administrator, Administrative Staff

FLSA: Non-Exempt

Position Purpose

This position will be responsible for key Provider Relations data entry required for Credentialing and Claims processing systems.

Responsibilities of Data Entry, Provider Relations

Principle Duties

• Load provider data into Credentialing database, CACTUS.
• Data entry of changes to provider data into CACTUS system
• Data entry of Delegated Providers into the CACTUS system
• Complete New Application Provider Data Sheets
• Maintain a tracking mechanism for the provider data sheet process
• Contacts originators of source documents to resolve questions, inconsistencies, or missing data.
• Prepares and sorts source documents, and identifies and interprets data to be entered.
• Reviews error reports and enters corrections into CACTUS system or completion of Provider Data Sheet.
• Routes source documents after entry
• Provide support and general administrative assistance to the contracting and credentialing teams when needed
• Provides routine office support such as making copies and or faxing
• Other duties as assigned
  

Requirements for Data Entry, Provider Relations

Qualifications

Education

• High school diploma or equivalent required preferred

Prior Related Experience

• Two (2) years of work experience doing data entry and or administration support in an office setting

Employment Eligibility

• Candidate has not been sanctioned or excluded from participation in federal or state healthcare programs by a federal or state law enforcement, regulatory, or licensing agency.

Knowledge, Skills, and Abilities

• Good oral and written communication skills.
• Ability to meet scheduled deadlines with minimal supervision.
• Strong organizational skills and accurate work results.
• Ability to maintain a professional demeanor and confidentiality

Sensory / Physical / Mental Requirements

Sensory:

• Speaking, hearing, near vision, far vision, depth perception, peripheral vision, touch, smell, and balance.

Physical:

• Extended periods of sitting, computer use, talking and possibly standing.
• Simple grasp, firm grasp, fine manipulation, pinch, finger dexterity, supination/pronation, wrist flexion.

Mental:

• Frequent decision-making.
• Ability to gather and assess data, determine appropriate actions, apply protocols and knowledge to unique situations, problem-solve and provide consultation.

Work Environment

Office environment with frequent environmental exposure to low-grade radiation from computer monitors; fast paced with frequent interruptions.

Protected Health Information (PHI) Access

Community Health Plan employees will encounter protected health information in the regular course of their work at and for Community Health Plan. Community Health Plan is a Covered Entity engaging in Health Care Service Contractor treatment, payment and operations. The following scale intends to provide some indication of how often the employee may encounter or work with PHI in this particular role. All PHI shall be used and disclosed on a Need To Know Basis and according to HIPAA Privacy Rules Part 164. In addition, every employee shall sign a confidentiality agreement as a condition of employment and violation of that agreement and/or Community Health Plan policies can be cause for termination.

PHI is defined at 164.103 as:

"Protected health information means the individually identifiable health information that is

• Transmitted by electronic media
• Maintained in electronic media
• Transmitted or maintained in any other form or medium.

Individual means the person who is the subject of protected health information.
Individually identifiable health information is information that is a subset of health information, including demographic information collected from an individual, and:

• Is created or received by a health care provider, health plan, employer, or health care clearinghouse; and
• Relates to the past, present, or future physical or mental health or condition of an individual; the provision of health care to an individual; or the past, present, or future payment for the provision of health care to an individual; and
• That identifies the individual; or
• With respect to which there is a reasonable basis to believe the information can be used to identify the individual.

This position as described will use, encounter, read, create, disclose and or work with in general, PHI that is created by or received by Community Health Plan:

• Frequent - The position has frequent and/or daily access and responsibility for PHI. Need to know.

In all cases, PHI use and disclosure is limited to the minimum necessary amount of PHI needed to complete the treatment, payment or operations.

The above is intended to describe the general content of and the requirements for satisfactory performance in this position. It is not to be construed as an exhaustive statement of the duties, responsibilities or requirements of this position.