Provider Data Management Specialist

Beth Israel Lahey Health•Wakefield, MA

About The Position

The Provider Data Management Specialist is responsible for the day-to-day administration, maintenance, support, and optimization of database systems that support provider credentialing, privileging, and enrollment functions. This role serves as the primary functional and technical resource for credentialing-related databases, ensuring data integrity, system effectiveness, reporting accuracy, and compliance with organizational and regulatory requirements. The Provider Data Management Specialist partners with internal stakeholders, vendors, and information systems teams to support provider data management and operational processes.

Requirements

High School Diploma or GED required.
Knowledge of MD-Staff credentialing software and associated applications strongly preferred.
Experience supporting MD-Staff system administration, provider data management, reporting, workflow configuration, and credentialing database maintenance preferred.
Knowledge of credentialing, privileging, provider enrollment, and practitioner data management processes within a healthcare environment.
Strong understanding of database management principles and system administration.
Advanced analytical and reporting skills, including data collection, validation, management, and presentation.
Experience supporting application management, testing, and project implementation activities.
Proficiency with Microsoft Office Suite, including Excel reporting and data analysis tools.
Excellent written, verbal, organizational, and interpersonal communication skills.
Ability to prioritize multiple assignments and work independently in a fast-paced healthcare environment.

Nice To Haves

Associate degree in Computer Science, Information Technology, Health Information Management, Business Administration, or a closely related field preferred.

Responsibilities

Administer and maintain databases utilized to support credentialing, privileging, and provider enrollment operations.
Serve as the functional and technical subject matter expert for credentialing database applications.
Monitor system performance and data quality to ensure accurate, timely, and reliable information.
Coordinate with software vendors and information technology teams on system enhancements, upgrades, troubleshooting, and issue resolution.
Ensure database integrity, security, confidentiality, and compliance with applicable organizational policies and standards.
Develop, maintain, and update system configuration elements, forms, templates, rosters, reports, and tracking mechanisms.
Manage CAQH data support.
Manage the provider enrollment platform.
Oversee data governance and audits.
Provide NCQA/CMS/accreditation reporting support.
Ensure provider directory data integrity.
Provide cross-functional support for Credentialing, Enrollment, and Facility Credentialing operations.
Generate routine and ad hoc reports to support operational, regulatory, and leadership needs.
Analyze and validate provider and credentialing data to support business decision-making and compliance activities.
Develop reports and data extracts to support credentialing, privileging, enrollment, and operational initiatives.
Maintain accurate provider data and support data governance efforts.
Provide training and ongoing support to database users.
Serve as a liaison among Medical Staff Services personnel, operational leaders, information systems teams, and external vendors.
Support system implementations, upgrades, testing, and process improvement initiatives.
Promote excellent customer service and collaborative relationships with internal and external stakeholders.
Maintain compliance with all organizational confidentiality, privacy, and security requirements.
Participate in quality improvement initiatives and departmental projects.
Complete required education and training programs.
Perform additional duties and special projects as assigned to support operational needs.