Provider Data Representative

General Dynamics Information Technology•USA GA Home Office (GAHOME), GA

13d•$72,877 - $98,599•Remote

About The Position

The Provider Data Representative ensures complete, accurate, and timely provider demographic, participation, credentialing, enrollment, roster, and directory information across systems supporting the World Trade Center Health Program (WTCHP). The role safeguards provider data integrity to support accurate claims payment, credentialing compliance, provider directory accuracy, and network participation. The Representative partners with Provider Relations, Credentialing, Provider Data, Claims Operations, and Contracting to keep provider information comprehensive, correct, and aligned with program and organizational standards.

Requirements

Bachelor’s degree preferred.
3+ years of experience in provider data, credentialing, enrollment, or health plan operations.
Strong analytical skills and proficiency in Microsoft Excel.
Exceptional attention to detail and accuracy.
Data governance and quality management
Analytical thinking and problem solving
Process improvement mindset
Attention to detail
Strong written and verbal communication
Collaboration and teamwork

Nice To Haves

Experience supporting federal or government‑sponsored healthcare programs.
Knowledge of provider directory regulatory requirements and healthcare data standards.
Experience with provider portals, enrollment systems, or enterprise provider data platforms.

Responsibilities

Maintain high accuracy standards for provider directory data.
Support issue resolution that reduces member and provider complaints arising from directory discrepancies.
Process demographic changes, additions, terminations, and updates within service‑level expectations.
Reduce backlog and improve turnaround time through efficient workflow management.
Validate and maintain NPIs, TINs, specialties, practice locations, affiliations, licensure, and EFT data.
Identify and reduce claims‑impacting data error rates; support audit readiness.
Reconcile provider rosters against credentialing, enrollment, claims, and directory systems.
Identify discrepancies affecting participation or claims payment and coordinate timely correction with cross‑functional teams.
Validate provider demographic data required for onboarding, credentialing, and recredentialing.
Identify and resolve participation or enrollment inconsistencies to ensure timely activation.
Identify data issues impacting claims adjudication, reimbursement, or provider participation.
Partner with Claims Operations to resolve discrepancies and support root‑cause analysis.
Generate dashboards, productivity logs, discrepancy reports, and data quality metrics.
Track turnaround times, accuracy rates, and productivity; provide insights to leadership for continuous improvement.
Communicate data requirements, corrections, and discrepancies to credentialing, enrollment, and provider relations teams.
Maintain clear documentation supporting provider updates and operational workflows.
Recommend workflow enhancements, automation opportunities, and system updates.
Support implementation of new tools, templates, and operational processes.

Benefits

Full-flex work week
401K with company match
Comprehensive health and wellness packages
Internal mobility team dedicated to helping you own your career
Professional growth opportunities including paid education and certifications
Cutting-edge technology you can learn from
Rest and recharge with paid vacation and holidays
Variety of medical plan options, some with Health Savings Accounts
Dental plan options
Vision plan
401(k) plan offering the ability to contribute both pre and post-tax dollars up to the IRS annual limits and receive a company match
Full flex work weeks where possible
Variety of paid time off plans, including vacation, sick and personal time, holidays
Paid parental, military, bereavement and jury duty leave
15 days of paid leave per calendar year to be used for vacations, personal business, and illness
10 paid holidays per year
Paid leave and paid holidays are prorated based on the employee’s date of hire
Paid Family Leave program provides a total of up to 160 hours of paid leave in a rolling 12 month period for eligible employees
Short and long-term disability benefits
Life, accidental death and dismemberment, personal accident, critical illness and business travel and accident insurance are provided or available