Under the direction of the manager, the Provider Data Specialist is responsible for maintaining accuracy of provider data in both internal and external databases. This position is expected to work effectively with internal and external contacts in an effort to meet all regulatory and industry provider data quality and accuracy standards. This position performs a variety of administrative and managed care contract support functions to ensure health plan requirements for provider enrollment and reimbursement are identified, communicated and coordinated both internally and with Phoenix Children's Medical Group contracted health plans.

1. Collects all credentialing and other data needed to enroll Phoenix Children's Medical Group (PCMG) providers in health plans. Interacts with other internal departments and provider to secure needed information. Maintains provider paper and electronic data files for all PCMG providers, including pertinent demographic and credential information needed for provider enrollment. Scans, files, and archives documentation as needed.
2. Performs timely and accurate data entry. Identifies extraordinary information, discrepancies, time gaps, and other idiosyncrasies that could adversely impact ability to enroll providers and, ultimately to bill and to obtain reimbursement for services rendered.
3. Completes health plan enrollment applications for PCMG via paper or electronic means, as necessary assuring that plan deadlines are met. Serves as primary contact for any provider information needs and works with health plans to resolve provider data issues; Tracks initial and follow-up communications / correspondence with providers, health plans and others, as needed. Prepares materials for internal and external managed care communications and correspondence related to provider enrollment.
4. Maintains Internal and external databases to assimilate and track health plan enrollment including (but not limited to) the NPPES Website, PECOS and CAQH systems to submit provider data as required by some health care organizations to credential individual providers. Prepares standard and ad-hoc reports as needed. Analyzes and maintains all reports related to provider enrollment with contracted health plans. Conducts audits of health plan provider information to ensure accurate provider data is conveyed to plan.
5. Participates in the evaluation and/or development of new procedures, protocols, and quality improvement initiatives. Proactively evaluates practices and assists in efforts to enhance effectiveness of methods.
6. Performs miscellaneous job related duties as requested.

Mission

To advance hope, healing and the best healthcare for children and their families

Vision

Phoenix Children's will be the leading pediatric health system in the Southwest, nationally recognized for exceptional care, innovative research and advanced medical education.

We realize this vision by:

• Offering the most comprehensive care across ages, communities and specialties
• Investing in innovative research, including emerging treatments, tools and technologies
• Advancing education and training to shape the next generation of clinical leaders
• Advocating for the health and well-being of children and families

Values

• We place children and families at the center of all we do
• We deliver exceptional care, every day and in every way
• We collaborate with colleagues, partners and communities to amplify our impact
• We set the standards of pediatric healthcare today, and innovate for the future
• We are accountable for making the highest quality care accessible and affordable