Data Management Specialist II

Cambridge MA 02141 58 Charles Street

Job Description

Data Management Specialist will perform the following duties and responsibilities:

* Perform review, validation and accurate record set-up and data entry
* High familiarity with Excel spreadsheets required - bonus if familiar with QNXT system, but not required.
* Ensure providers are appropriately and accurately data entered into the QNXT system
* High level of data entry accuracy required - understanding of health insurance plans, provider information is a plus
* Understanding of NPI numbers, Tax ID numbers, billing structures for providers a plus
* Ability to validate provider data against multiple sources, QA data elements and correct errors
* Understanding of credentialing processes for providers helpful
* Ability to work independently, and also with a team, giving attention to details, but process work quickly and efficiently necessary.

Responsible for timely and accurate data entry and maintenance of provider records or credentialing and contract information in multiple databases. Researches and resolves questions and complaints, and ensures that information in all databases is accurate and properly configured to support operations. May help train lower level peers.

Essential Functions

- Performs review, correspondence and timely, accurate record set-up and data entry. Supports internal auditing process to ensure data accuracy and integrity.
- Researches and resolves issues and ensures systems are updated, timely, appropriately and accurately.
- Responds to requests to update or change information and ensures that all changes are made within operational guidelines and accurately support all other systems related functions.
- Researches and responds to providers and other internal staff regarding complex inquiries. Develops solutions and communicates outcomes by telephone and in writing.
- Supports the implementation of new business by ensuring providers are appropriately and accurately loaded in all applicable systems.
- Records daily activities using electronic and manual systems as directed.
- Provides consultation and information to area offices regarding the composition of the provider network or specific provider statuses. Forwards provider requests for network inclusion to the area offices for review and approval.
- Assists representatives with detailed information in order to answer provider questions and returns provider calls, as requested, to communicate resolution and/or appropriate course of action.
- Performs other duties and special projects as assigned.

General Job Information


Data Management Specialist II



Job Family

General Services Group


United States of America

FLSA Status

United States of America (Non-Exempt)

Recruiting Start Date


Date Requisition Created


Work Experience

Customer Service


Associates, GED (Required), High School (Required)

License and Certifications - Required

License and Certifications - Preferred

Other Job Requirements


Managed care or other healthcare network development experience preferred.Ability to type 45-50+ words per minute. Other standard office equipment including telephone, copy machines, personal computer software and mainframe/LAN data systems. Must possess a high level of technical aptitude and be able to organize and manage information in multiple system environments; manage multiple priorities, pay close attention to detail as well as be proficient in word processing and spreadsheet applications. Proven customer service skills and the ability to successfully analyze and procure solutions to problems in a fast paced production based environment.- 2 or more years experience in customer service, data management, communications, or credentialing verifications required. - 2 or more years experience in a behavioral health or related industry.

Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, comply and attest to the security responsibilities and security controls unique to their position.