Provider Data Specialist - Remote

Overview

The Provider Data Specialist is responsible for ensuring the accuracy of provider information across multiple internal systems and supporting data integrity for claims payment, provider directories, network participation, and credentialing workflows.

In Short

• Ensure accuracy of provider information across systems.
• Support data integrity for claims payment and provider directories.
• Coordinate credentialing activities and maintain high-quality provider data.
• Perform routine roster reconciliation with provider groups.
• Conduct data integrity audits and prepare provider reports.
• Collaborate with various departments to resolve data discrepancies.
• Assist with primary-source verification for credentialing.
• Maintain and update credentialing database.
• Review federal/state sanctions for providers.
• Provide excellent customer service and support to providers.

Requirements

• 3+ years in provider data management or credentialing support.
• Knowledge of Medicare Advantage provider requirements.
• Experience with data accuracy workflows and reconciliation.
• Ability to analyze large data sets.
• Familiarity with health insurance operations and terminology.
• Excellent communication and stakeholder management skills.
• Ability to multi-task and stay organized.
• Proficiency with Microsoft Office, advanced Excel preferred.

Benefits

• Competitive salary based on the market.
• Medical, Dental, and Vision insurance.
• Employer-Paid Life Insurance.
• Paid Maternal and Paternal Leave.
• 401(K) match up to 4%.
• Paid-Time-Off.
• Employee Assistance Programs.
• Supplemental benefits including Spouse Insurance, Pet Insurance, etc.