Provider Data Specialist

Job Summary

To support the management of provider data, the full-time Provider Data Specialist will educate, verify, and maintain demographic and payee data for over 80,000 practitioners, ensuring accuracy in the Provider Directory and claims processing while working remotely.

Key responsibilities

• Create and manage records for contracted and non-contracted providers in the provider databases
• Review and update existing provider, office, and payee records based on documentation and internal requests
• Conduct audits and provide guidance on claims processing while maintaining compliance with IRS standards for payees

Required qualifications

• 4-5 years of experience in a managed care organization focusing on Provider Data Management or related fields
• Associate or Bachelor's degree preferred, or a combination of education and work experience
• Experience managing provider, office, and payee data, as well as claims processing
• Knowledge of CMS Provider Directory regulations
• Proficiency in Microsoft Office Suite, particularly Excel and Access