Provider Data Management Specialist
Enlyte•UNAVAILABLE, UNAVAILABLE
•Remote
About The Position
The Provider Data Specialist maintains and ensures accuracy of provider network data for delegated group providers. This role is critical in supporting proper claims processing, provider reimbursement, and member access to accurate provider directory information. The position requires strong analytical skills, attention to detail, and proficiency in Excel data manipulation. As a Provider Data Specialist, you will be responsible for maintaining provider data integrity within our systems.
Requirements
- Bachelor's degree in healthcare administration, information management, or related field, or equivalent experience preferred
- 2+ years of experience in healthcare data management or similar role required
- Must have strong proficiency in Excel, including advanced functions, data manipulation, and validation techniques
- Understanding of healthcare provider networks and relationships
- Ability to understand contract hierarchies and their impact on provider data management
- Familiarity with medical terminology, degrees, specialties, and licensing requirements
- Analytical thinking skills with ability to recognize patterns and make data-driven decisions
- Attention to detail and commitment to data accuracy
- Problem-solving skills to address data integrity issues
Nice To Haves
- Experience working with provider data management systems preferred
- Experience with healthcare information systems preferred
Responsibilities
- Process and validate provider data submissions received in Excel format, ensuring accurate system integration
- Review system updates and error messages post-automation to verify data accuracy
- Perform manual corrections and updates when automated processes cannot resolve data integrity issues
- Manipulate Excel data files to ensure proper formatting for system compatibility
- Validate incoming provider data against existing system information
- Maintain data that drives claim pricing and referrals
- Analyze contract priorities and relationships between provider groups and locations
- Make informed decisions about data management based on analytical findings
Benefits
- Medical
- Dental
- Vision
- Health Savings Accounts / Flexible Spending Accounts
- Life and AD&D Insurance
- 401(k)
- Tuition Reimbursement
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
