Provider Data Representative

General Dynamics Information Technology • USA VA Home Office (VAHOME), VA

2d • $23 - $31 • Remote

About The Position

The Provider Data Representative maintains accurate provider demographic, participation, credentialing, enrollment, roster, and directory information across all systems supporting the World Trade Center Health Program (WTCHP). The role ensures 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 complete, accurate, timely, and compliant with organizational standards.

Requirements

• Associates Degree
• 3+ 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.

Nice To Haves

• Bachelor’s degree preferred.
• 5+ years of relevant experience.
• 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

• Directory accuracy & completeness: Meet internal standards and regulatory expectations; reduce member/provider complaints due to directory errors.
• Maintenance timeliness: Process updates, additions, terminations, and changes within SLAs; reduce cycle time and backlog.
• Data integrity: Improve audit scores; lower claims‑impacting data error rates; maintain accurate NPIs, TINs, specialties, practice locations, affiliations, licenses, and EFT details.
• Roster reconciliation effectiveness: Validate rosters against credentialing, enrollment, terms & conditions, claims, and directory data; correct discrepancies promptly.
• Credentialing & enrollment support: Ensure data readiness for onboarding and recredentialing; reduce participation activation delays.
• Operational reporting: Provide clear dashboards and logs for productivity, turnaround times, accuracy, and issue remediation.
• Process provider roster submissions and updates.
• Maintain accurate provider demographic, enrollment, and participation records.
• Validate and update NPIs, TINs, specialties, practice locations, EFT details, and affiliations.
• Ensure timely changes supporting accurate claims payment and directory publication.
• Reconcile provider rosters against credentialing, claims, enrollment, and directory systems.
• Identify discrepancies impacting participation, claims payment, or directory accuracy.
• Coordinate corrections with Provider Relations, Credentialing, and Provider Data teams.
• Validate provider demographic information for credentialing/recredentialing.
• Identify and resolve enrollment and participation discrepancies.
• Ensure data requirements are complete for onboarding and participation activation.
• Audit provider records for completeness, accuracy, and compliance.
• Monitor directory accuracy, quality scores, and claims‑impacting error rates.
• Support development of data standards, QA programs, and process improvements.
• Identify provider data issues affecting claims adjudication, reimbursement, and participation.
• Collaborate with Claims Operations to resolve data discrepancies; support root‑cause analysis and remediation.
• Produce provider data quality reports, discrepancy logs, and audit results.
• Track maintenance productivity, turnaround times, and accuracy metrics.
• Provide insights to leadership to guide operational improvements.
• Communicate data requirements and discrepancies to credentialing, enrollment, and provider relations teams.
• Provide clear documentation for provider updates and requests.
• Recommend system enhancements, automation opportunities, and updated workflows.
• Support implementation of new processes, templates, and operational tools.

Benefits

• Medical plan options
• 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 leave
• Military leave
• Bereavement leave
• 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 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 insurance
• Accidental death and dismemberment insurance
• Personal accident insurance
• Critical illness insurance
• Business travel and accident insurance

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree