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011190 CCA-Network Ops & Strategic Initiatives

Position Summary:

Reporting to the Director, Provider Network Strategic Initiatives & Data Management, the Provider Data Outreach Specialist is responsible for executing outbound call campaigns to healthcare providers to collect and validate information such as Provider Ownership Disclosure Forms and practice contact information. This role ensures accurate data collection, tracks call outcomes, follows established workflows, and shares information with the Provider Data Management (PDM) team. The incumbent will maintain thorough documentation of all interactions and collaborate with internal teams to support provider data accuracy and compliance.

Supervision Exercised:

• No, this position does not have direct reports.

Massachusetts Market Contract Key Personnel:

• No, this position is not identified in the contract/s as key personnel.

Essential Duties & Responsibilities:

• Execute outbound call campaigns to providers to collect and verify information.

• Track and report outcomes of outbound calls accurately.

• Follow established processes and workflows for provider outreach and data collection.

• Document all provider interactions in alignment with established process.

• Share collected information and updates with the Provider Data Management team.

• Escalate issues or discrepancies according to established protocols.

• Maintain confidentiality and adhere to compliance standards during all interactions.

• Collaborate with internal teams to ensure provider data integrity.

Working Conditions:

• Standard office conditions.

Required Education (must have):

• Associate degree or Post High School Training/ Certification/ Education Required.

Desired Education (nice to have):

• A bachelor’s degree in any general or health-oriented fields is preferred.

Required Experience (must have):

• At least 1 year of previous experience in a customer service/call center role

• Must have customer service experience

Desired Experience (nice to have):

• At least 1 year of previous experience in a healthcare setting, strongly preferred.

• Familiarity with medical terminology, preferred.

• Previous experience Medicare and Medicaid strongly preferred

Required Knowledge, Skills & Abilities (must have):

• Knowledge of healthcare systems/services and/or experience with community organizations, social services, and public resources.

• Must be a self-starter with a high level of accountability and responsibility.

• Must have excellent time management skills.

• Must possess exceptional interpersonal and presentation skills.

• Must be able to meet directly with providers in office settings.

• Must have the ability to work in a multicultural environment and perform outreach related activities.

• Must be able to work independently as well as within a team environment, be flexible, highly organized and be able to prioritize their work.

• Is able to work in a positive and collaborative manner with co-workers

• Must have knowledge of appropriate phone etiquette.

• Must have excellent verbal and written communication skills.

• Must have proficiency in Microsoft Office

Required Language (must have):

• English Required

Desired Knowledge, Skills, Abilities & Language (nice to have):

• Thorough knowledge of Medicare & Medicaid services policies and guidelines.

• Provider Data Management and/or Credentialing knowledge

EEO is The Law

Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled

Please note employment with CCA is contingent upon acceptable professional references, a background check (including Mass CORI, employment, education, criminal check, and driving record, (if applicable)), an OIG Report and verification of a valid MA/RN license (if applicable). Commonwealth Care Alliance is an equal opportunity employer. Applicants are considered for positions without regard to veteran status, uniformed service member status, race, color, religion, sex, national origin, age, physical or mental disability, genetic information or any other category protected by applicable federal, state or local laws.