Jobs in the United States

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System Engineer
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CareOregon, Inc.

Provider Data Specialist I

Remote, United States

$23.28 - $28.45

Apply on careoregon.wd12.myworkdayjobs.com About employer

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Job details

Pay: $23.28 - $28.45
Posting language: English
Posted: Nov 12, 2026

Original job description

Provider Data Specialist I--------------------------------------------------------------- This position is responsible for providing product support to provider data within the QNXT module. Primary tasks include adding, maintaining, and updating provider data records, as well as assistance with database integrity. Correctly configure provider data and contract information using written guidelines. Accurate and timely provider data plays a critical role in the success of claims payment, OHA Health Systems (DMAP) and CMS encounter data submission, PCP assignment, authorization processing, credentialing, IRS reporting, regulatory projects, and the provider directory.

Estimated Hiring Range:

$23.28 - $28.45

Bonus Target:

Bonus - SIP Target, 5% Annual

Priority will be given to candidates residing in Oregon and Southwest Washington.

Current CareOregon Employees: Please use the internal Workday site to submit an application for this job. --------------------------------------------------------------- Essential Responsibilities Provider Database Maintenance

Perform accurate and timely data entry into provider database, following Provider Data policies and procedures.
Provide data management and process knowledge to the organization; assist with projects.
Investigate and resolve provider and provider contract pending claims as requested by more advanced Provider Data staff; apply claims policies and procedures.
Monitor call and email queues by reviewing requests and communicating clearly and timely with contracted provider offices and internal customers; research demographic and affiliations changes; make updates to provider database reflecting new information once validated.
Manage monthly provider rosters received from contracted hospital systems and IPAs by investigating changes and validating information prior to updating QNXT; consult with advanced Provider Data staff to clarify information.
Complete provider database projects resulting from contracting, configuration, or regulatory changes.
Sort incoming faxes, PIVs and distribute according to assignments.
Maintain SharePoint libraries according to unit protocols.
Enroll providers with OHA Health Systems using MMIS web enrollment portal.
Reroute critical pieces of return mail including 1099s, live checks and remittance advice by investigating demographic discrepancies and reflecting changes in QNXT.
Troubleshoot and investigate provider portal issues when they arise.

Provider Database Integrity

Troubleshoot provider setup to support provider reporting, directory, and claims operation.
Perform testing of new software versions.
Data validation through license boards, IRS, NPPES, and other third-party verification.
Resolve data errors through troubleshooter processes and internal audits.

Experience and/or Education Required

Minimum 1 year of experience with data configuration, data management, credentialing, or claims management

Preferred

2 years of experience working in health care/insurance
Experience with managed care and/or project participation

Knowledge, Skills and Abilities Required Knowledge

Familiarity with relational databases
General understanding of or ability to learn managed care and Oregon Health Plan concepts
Familiarity with Microsoft Office Suite products, especially Excel

Skills and Abilities

Ability to learn and effectively navigate claims processing technologies, such as QNXT and Facets
Ability to learn and effectively navigate document management and collaboration platforms, such as SharePoint and Office 365
Ability to follow policies and procedures in performing job responsibilities
Ability to develop skills around troubleshooting data integrity issues and root cause
Ability to learn how to author and maintain process documentation
Proficient communication skills, including listening, verbal, written, and customer service
Ability to articulate instructions
Learning to convey appropriate level of detail effectively to multiple levels of the organization including non-technical staff
Ability to learn to appropriately communicate status and needs
General ability to learn to handle multiple priorities and requests
Demonstrates general initiative and motivation
Ability to effectively collaborate with coworkers
Attention to details and deadlines
Ability to learn to see the big picture
Developing organizational skills
Ability to prioritize work based on direction
Ability to develop analytical and research skills
Ability to maintain a positive attitude
Ability to learn governance and process
Ability to work effectively with diverse individuals and groups
Ability to learn, focus, understand, and evaluate information and determine appropriate actions
Ability to accept direction and feedback, as well as tolerate and manage stress
Ability to see, read, and perform repetitive finger and wrist movement for at least 6 hours/day
Ability to hear and speak clearly for at least 3-6 hours/day

Working Conditions Work Environment(s): ☒ Indoor/Office ☐ Community ☐ Facilities/Security ☐ Outdoor Exposure Member/Patient Facing: ☒ No ☐ Telephonic ☐ In Person Hazards: May include, but not limited to, physical and ergonomic hazards Equipment: General office equipment Travel: May include occasional required or optional travel outside of the workplace; the employee’s personal vehicle, local transit or other means of transportation may be used Work Location: Work from home Schedule: Monday - Friday, 8:00 AM - 5:00 PM

We offer a strong Total Rewards Program. This includes competitive pay, bonus opportunity, and a comprehensive benefits package. Eligibility for bonuses and benefits is dependent on factors such as the position type and the number of scheduled weekly hours. Benefits-eligible employees qualify for benefits beginning on the first of the month on or after their start date. CareOregon offers medical, dental, vision, life, AD&D, and disability insurance, as well as health savings account, flexible spending account(s), lifestyle spending account, employee assistance program, wellness program, discounts, and multiple supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, 529 College Savings, etc.). We also offer a strong retirement plan with employer contributions. Benefits-eligible employees accrue PTO and Paid State Sick Time based on hours worked/scheduled hours and the primary work state. Employees may also receive paid holidays, volunteer time, jury duty, bereavement leave, and more, depending on eligibility. Non-benefits eligible employees can enjoy 401(k) contributions, Paid State Sick Time, wellness and employee assistance program benefits, and other perks. Please contact your recruiter for more information.

We are an equal opportunity employer CareOregon is an equal opportunity employer. The organization selects the best individual for the job based upon job related qualifications, regardless of race, color, religion, sexual orientation, national origin, gender, gender identity, gender expression, genetic information, age, veteran status, ancestry, marital status or disability. The organization will make a reasonable accommodation to known physical or mental limitations of a qualified applicant or employee with a disability unless the accommodation will impose an undue hardship on the operation of our organization.

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Jobs in the United States