Provider Data Representative

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

📋 Description

• Ensure the accuracy of provider directory information.

• Address issues stemming from directory inconsistencies.

• Manage changes to provider demographics, including additions, terminations, and updates, while adhering to service-level expectations.

• Minimize backlog and enhance turnaround times through effective workflow management.

• Verify and maintain NPIs, TINs, specialties, practice locations, affiliations, licensure, and EFT information.

• Detect and mitigate data errors that impact claims and assist in maintaining audit readiness.

• Reconcile provider rosters with credentialing, enrollment, claims, and directory systems.

• Collaborate with cross-functional teams to rectify participation and claims-payment discrepancies.

• Confirm provider demographic data for onboarding, credentialing, and recredentialing processes.

• Resolve inconsistencies related to participation or enrollment.

• Identify data-related issues affecting claims adjudication, reimbursement, or provider engagement.

• Work alongside Claims Operations to resolve discrepancies and conduct root-cause analysis.

• Create dashboards, productivity logs, discrepancy reports, and metrics for data quality.

• Monitor turnaround times, accuracy rates, and productivity while providing insights for leadership.

• Convey data requirements, corrections, and discrepancies to credentialing, enrollment, and provider relations teams.

• Maintain documentation that supports provider updates and operational processes.

• Suggest improvements to workflows, identify automation opportunities, and recommend system updates.

• Assist in the implementation of new tools, templates, and operational processes.

⛳️ Requirements

• A minimum of 3 years of experience in provider data management, credentialing, enrollment, or health plan operations.

• Strong analytical capabilities.

• Proficient in Microsoft Excel.

• Outstanding attention to detail and accuracy.

• A Bachelor’s degree is preferred.

• Experience in supporting federal or government-sponsored healthcare programs is preferred.

• Familiarity with provider directory regulatory standards and healthcare data requirements is preferred.

• Experience with provider portals, enrollment systems, or enterprise provider data platforms is preferred.

• US Citizenship is not required.

• Travel requirement: Less than 10%.

🏝️ Benefits

• Full-flex work week.

• 401K plan with company matching.

• Comprehensive health and wellness benefits.

• Internal mobility support.

• Opportunities for professional growth, including funded education and certifications.

• Access to cutting-edge technology for learning purposes.

• Paid vacation and holidays.

• Various medical plan options, including those with Health Savings Accounts.

• Dental coverage options.

• Vision insurance.

• Paid sick and personal leave.

• Paid parental, military, bereavement, and jury duty leave.

• Up to 160 hours of paid family leave over a rolling 12-month period for eligible employees.

• Short-term and long-term disability benefits.

• Life insurance coverage.

• Accidental death and dismemberment insurance.

• Personal accident insurance.

• Critical illness insurance.

• Business travel and accident insurance.