Network Data Specialist I

Solis Health Plans• Doral, FL, US, FL

4d•$22 - $24•Onsite

About The Position

The Network Data Specialist is responsible for the accurate and timely loading, maintenance, and validation of provider data. This role ensures that both participating and non-participating providers are correctly configured in claims and provider systems to support accurate claims adjudication, network management, and regulatory compliance. The Specialist partners closely with Provider Relations, Credentialing, and Claims teams to ensure provider data integrity and support monthly provider roster management and system synchronization across multiple platforms.

Requirements

High School Diploma or GED required.
Minimum of 3 years of experience in healthcare provider data management, claims systems, credentialing support, or managed care operations.
Experience working with provider databases, claims systems, or network configuration tools.
Equivalent combination of education and experience may be considered.
Strong attention to detail and data accuracy
Ability to manage large volumes of provider data efficiently
Strong analytical and problem-solving skills
Understanding of healthcare provider data structures and systems
Ability to collaborate effectively with cross-functional teams
Strong organizational and time management skills
Ability to work independently in a production-driven environment

Nice To Haves

Experience in managed care health plan or health insurance environment.
Familiarity with provider credentialing and contracting processes.
Understanding of provider taxonomy, NPI, and healthcare provider identifiers.
Experience managing provider rosters or large-scale data files.
Knowledge of claims adjudication systems and network configuration rules.

Responsibilities

Load contracted (participating) providers into provider and claims systems in accordance with executed provider agreements and configuration requirements.
Load and maintain non-participating provider records to ensure accurate claims processing and pricing.
Maintain accurate, complete, and up-to-date provider data across all claims and provider databases.
Ensure integrity of critical provider information including: Provider demographics, Tax ID and billing information, Specialty and taxonomy codes, Network participation status, Contract effective dates and terms.
Validate provider data accuracy prior to system loading and ongoing updates.
Apply business rules and system requirements to ensure proper configuration across all downstream applications.
Synchronize provider data across multiple claims, provider, and configuration systems.
Ensure consistency of provider information across enterprise platforms.
Identify and resolve data discrepancies between systems and source documentation.
Support updates to provider files based on contracting, credentialing, or network changes.
Partner with Provider Relations to support onboarding, updates, and maintenance of contracted providers.
Work closely with Credentialing teams to ensure only appropriately credentialed providers are loaded and active in systems.
Validate credentialing status and ensure alignment with network participation requirements prior to system activation.
Support resolution of provider data issues identified by internal stakeholders or external providers.
Load and maintain non-par provider records to ensure accurate claims routing and pricing logic.
Ensure non-participating provider data supports correct claims adjudication and out-of-network processing rules.
Maintain accurate classification of provider participation status across systems.
Manage monthly provider roster updates, including additions, terminations, and changes.
Reconcile provider rosters received from external sources against internal systems.
Validate and distribute provider roster files to appropriate internal stakeholders.
Support reporting needs related to provider network composition and data accuracy.
Validate provider data against contractual requirements, network standards, and system specifications.
Ensure compliance with internal policies and regulatory requirements related to provider data management.
Maintain audit-ready documentation of provider data changes and updates.
Support internal and external audits by providing accurate provider data records.