Data Entry Specialist, Healthcare Claims (hybrid)

14560 - Data Entry Specialist, Healthcare Claims (hybrid) -

Pierre, SD Start Date:

ASAP Type:

Temporary Project Estimated Duration:

12+ months with possible extensions

Work Setting:

some onsite/virtual collaboration. Only candidates able to relocate as required should apply to avoid removal from future consideration.

Required:

• Experience performing high‑volume data entry, processing, review, and verification tasks in an office or healthcare/claims environment.
• Experience to accurately enter, review, and verify data using multiple systems such as mainframe applications, Datacap, Provider Enrollment Portal, and File Director.
• Experience reviewing records and documentation for completeness, accuracy, and compliance with established policies and procedures.
• Experience with healthcare claims documents, including CMS‑1500 and UB‑04/CMS‑1450 claim forms, and how data elements are used for processing.
• Experience verifying claim or enrollment data against multiple sources using both manual methods and technology‑based tools.
• Experience to index, organize, and categorize claims or related documents in electronic systems to support efficient retrieval and processing.
• Experience to follow detailed policies, procedures, and protocols related to data entry, data processing, review, verification, and quality control.
• Experience with standard office software and equipment and ability to perform other administrative and data entry tasks as assigned.

Preferred:

• Experience providing services directly to a Department of Social Services or similar public sector agency in the areas outlined in the scope of work.
• Familiarity with Datacap, Provider Enrollment Portal, and File Director specifically for claims or provider enrollment processing.
• Experience with healthcare claims processing workflows, including handling CMS‑1500 and UB‑04/CMS‑1450 forms and related documentation.
• Experience with department or agency policy and procedures, processes, and protocols for data verification, activity completion expectations, and quality control functions.
• Experience with provider enrollment and outreach processes, including managing stakeholder contact and outreach to providers.
• Experience scaling services up or down based on agency needs, as shown through past performance on similar engagements.
• Experience working within HIPAA requirements and in secure office environments handling protected health information (PHI). Responsibilities include but are not limited to the following:
• Perform accurate and timely data entry for claims, provider enrollment, and related information using mainframe systems, Datacap, Provider Enrollment Portal, File Director, and other designated applications.
• Review records and supporting documentation to ensure completeness, accuracy, and compliance with applicable policies, procedures, and program requirements.
• Verify data elements against various internal and external sources, using both manual review and technology tools, to support claim verification and provider enrollment decisions.
• Index, categorize, and maintain claims and related documents in electronic document management systems to support efficient processing and retrieval.
• Apply department policies and procedures for data entry, processing, review, verification, and quality control while maintaining confidentiality and HIPAA compliance.
• Conduct provider or stakeholder outreach to obtain missing information, clarify discrepancies, and support completion of enrollment, claims, or related processes by established deadlines.
• Monitor assigned work queues and tasks to ensure activities are completed within established timelines, perform quality control checks on completed work, and assist with other administrative and data entry duties as assigned.

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