QualChoice of Arkansas
 
Position Title

Data Entry Specialist

Job Title

Data Entry Specialist

Job Description

General Summary
The Data Entry Specialist is responsible for loading and maintaining the integrity of data within all transaction-based software applications that are the responsibility of the Business Unit.


Principal Duties and Responsibilities

Group/Member
• Set up of all new and renewing groups based on information provided.
• Processing of Group terminations within the transaction-based software application.
• Validate that groups are ready for premium billing and vendor extracts prior to releasing the group to other departments.

Provider
• Load newly contracted, credentialed and re-credentialed provider data into transaction-based software application that are the responsibility of the Business Unit based on information provided.
• Load updates to provider files for leased and delegated providers through monthly demographic change rosters.
• Load information regarding non-participating providers.

EDI
• Set up providers requesting 835 remittance reports in the software application.

General Support
• Responsible for archival of supporting documentation for Provider and Group load activities.
• Conduct periodic internal audits of data entered into software application.
• Maintain pre-defined level of data quality based on internal audits
• Performs other duties as assigned

Projects
• Timely and thorough execution of project deliverables
• Accurate and thorough test execution and documentation


Job Knowledge, Skills and Abilities
• Knowledge of claims processing as it relates to adjudication, coding, provider networks, and medical terminology.
• Detail oriented
• Self-motivated
• Ability to work well in a team environment
• Working knowledge of current Microsoft Office Outlook, Word and Excel.


Education and Experience
• Requires High School diploma or equivalent.
• Prefer 1 to 2 years’ work experience in a healthcare setting which predominately involved knowledge of computer data maintenance and provider or health plan operational practices.


Expectations of all QualChoice Staff

• Conducts business with high regard for corporate values and in compliance with its Code of Ethical Conduct.
• Maintains high regard for member privacy and complies with information security and HIPAA policies.
• Responsible for quality and continuous improvement within the job scope. Contributes to and supports the company’s quality initiatives.
• Accountable for all actions/responsibilities described in the company’s policies and procedures as they relate to this position.


Work Environment/Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• The work environment is a typical office environment.
• The noise level in the work environment is usually moderate.
• This is largely a sedentary role, requiring use of standard office equipment such as computers, phones, copiers/printers, and calculators.

Basic Qualifications

• High school diploma or equivalent.

• At least 1 to 2 years’ work experience in a healthcare setting which predominately involved knowledge of computer data maintenance and provider or health plan operational practices.

• Working knowledge of Microsoft Outlook, Word and Excel.

• Knowledge of claims processing as it relates to adjudication, coding, provider networks, and medical terminology.

 
 
   
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