Provider Data Management Data Analyst

This is a fully remote position, open to applicants in California.

📋 Description

• Analyze provider data to detect inaccuracies, missing details, duplicates, and inconsistencies.

• Conduct data validation, reconciliation, and quality assurance across various systems.

• Review provider demographic information, specialties, affiliations, licensure, credentialing, and participation details.

• Monitor data-quality trends and suggest corrective measures.

• Maintain standards, definitions, procedures, and documentation for data management.

• Assist with provider onboarding, recredentialing, updates, and terminations.

• Validate licenses, certifications, specialties, malpractice coverage, affiliations, and other credentialing components.

• Create and sustain provider rosters for submission to health plans and external partners.

• Extract, transform, format, and validate provider data in accordance with payer-specific requirements.

• Conduct pre-submission quality checks and address exceptions before delivery.

• Reconcile submitted rosters with source systems and feedback from health plans.

• Coordinate corrections, resubmissions, and status updates within established turnaround times.

• Develop both recurring and ad hoc reports concerning credentialing status, roster accuracy, data completeness, and operational performance.

• Monitor key performance indicators (KPIs) including data error rates, roster turnaround times, rejected records, and credentialing timeliness.

• Utilize Excel, SQL, Power BI, or other analytical tools to convert data into actionable insights.

• Present findings and recommendations to business partners and leadership.

• Collaborate with teams in credentialing, provider operations, contracting, network management, compliance, enrollment, and IT.

• Act as a subject matter expert in credentialing data and roster processes.

• Assist in testing and validation for system enhancements, integrations, and process modifications.

• Support internal, health plan, and regulatory audits.

• Identify opportunities to enhance efficiency in roster creation, validation, and reconciliation processes.

• Contribute to automation and workflow-improvement initiatives.

• Establish consistent controls for data accuracy, completeness, and timely submissions.

• Maintain version-controlled documentation and standard operating procedures.

• Advocate for consistent data governance practices throughout provider data workflows.

⛳️ Requirements

• Bachelor’s degree in Health Administration, Data Analytics, Business, Information Systems, or a related field, or equivalent experience.

• A minimum of three years’ experience in healthcare data analysis, provider data management, credentialing, provider enrollment, or a related field.

• Familiarity with provider data elements, including NPI, taxonomy, licensure, specialties, practice locations, and health plan participation.

• Proven experience in creating, validating, and submitting provider rosters.

• Advanced skills in Microsoft Excel, including pivot tables, lookups, filtering, and data reconciliation.

• Strong analytical, organizational, and problem-solving abilities.

• Exceptional attention to detail and capacity to manage competing deadlines.

• External candidates must pass a background check/drug screen.

• Compliance with applicable state requirements, CMS guidance, and accreditation standards is mandatory.

🏝️ Benefits

• Comprehensive medical, vision, and dental coverage.

• 401k savings plan with company matching.

• Flexible time off policy.

• Nine Paid Holidays.

• Eligibility for an annual bonus program.

• Competitive compensation package.

• Background check/drug screen required for external hires.