Provider Data Specialist

Job Summary

Managing provider data for a national network, the full-time Provider Data Specialist will be responsible for educating, verifying, and accurately maintaining demographic and payee data for over 80,000 ophthalmology and optometry practitioners, while working remotely.

Key responsibilities

• Create and manage records for contracted and non-contracted providers in the provider databases, ensuring accuracy for claims processing and authorizations
• Review and update existing provider, office, and payee records based on documentation and internal requests
• Conduct audits and resolve data discrepancies while providing education to providers and internal departments about the importance of accurate provider data

Required qualifications

• 4-5 years of experience in provider data management, credentialing, or related roles within a managed care organization
• Associate or Bachelor's degree preferred, or equivalent combination of education and experience
• Experience managing sensitive information, including Protected Health Information (PHI) and Personal Identifiable Information (PII)
• Knowledge of CMS Provider Directory regulations and experience with healthcare providers
• Proficiency in Microsoft Office Suite, including Excel, Word, Access, and PowerPoint