Provider Data Specialist

Zing Health

7d

About The Position

The Provider Data Specialist is responsible for ensuring the accuracy of provider information across multiple internal systems and supporting data integrity for claims payment, provider directories, network participation, and credentialing workflows. This role focuses on maintaining high-quality provider data, performing roster reconciliation, and provider credentialing support. Responsibilities include coordinating credentialing activities such as collecting provider documents, assisting with primary-source verification, and supporting compliance with CMS, NCQA, Medicare, Medicaid, and other regulatory standards.

The Provider Data Specialist serves as a key liaison between Provider Network Management, Credentialing, Compliance, and providers/provider organizations, ensuring timely, high-quality service and a positive provider experience.

Requirements

• 3+ years of experience in provider data management, credentialing support, provider relations, or managed care operations.
• Working knowledge of Medicare Advantage provider requirements relevant to data and directories.
• Hands-on experience with provider rosters, demographic maintenance, and data accuracy workflows, including reconciliation across multiple systems.
• Ability to analyze large data sets and reconcile provider information across disparate sources.
• Familiarity with health insurance operations and terminology (basic claims process; ICD-10, CPT, HCPCS; facility vs. professional billing).
• Excellent written and verbal communication, customer service, and stakeholder management skills.
• Demonstrated ability to multi-task while remaining well organized and detail oriented.
• Proficiency with Microsoft Office; advanced Excel preferred (e.q., VLOOKUP/XLOOKUP, pivot tables, text functions, data validation).

Nice To Haves

• Experience with provider data/credentialing platforms (e.g., CAQH, NPPES, NPDB)
• Experience working with delegated entities and interpreting roster file layouts.
• Exposure to data quality frameworks, data governance, or directory compliance.

Responsibilities

• Facilitate provider inquiries promptly and professionally; document issues, actions, and resolutions in designated systems.
• Maintain provider rosters and core data elements (demographics, specialties, affiliations, panel status, network participation, etc.)
• Perform routine roster reconciliation with delegated entities, provider groups, and facilities to ensure alignment with internal provider data systems.
• Configure and update providers (facilities, groups, ancillaries, practitioners) accurately for claims payment, reporting, and directory display.
• Conduct data integrity audits and reconciliation activities; identify, correct, and report discrepancies with clear remediation tracking.
• Prepare monthly/quarterly provider reports and extracts.
• Support CMS-compliant provider directory maintenance by ensuring timely, accurate updates to all required fields.
• Collaborate with Claims, Configuration, IT, Compliance, Member Services, and Network Management to resolve data discrepancies and improve workflows.
• Coordinate collection of credentialing materials (licenses, DEA/CDS, board certifications, malpractice coverage, etc.) from new and existing providers.
• Assist with primary-source verification support by gathering documentation and ensuring completeness and current status prior to credentialing review.
• Maintain and update credentialing database; ensure provider profiles reflect accurate credentialing and recredentialing statuses and dates.
• Conduct and manage credentialing audits with delegated groups.
• Review federal/state sanctions (OIG, state boards, Medicare opt-out listings)

Benefits

• A competitive salary based on the market
• Medical, Dental, and Vision
• Employer-Paid Life Insurance
• Paid Maternal Leave
• Paid Paternal Leave
• 401(K) match up to 4%
• Paid-Time-Off
• Employee Assistance Programs
• Several supplemental benefits are available, including, but not limited to, Spouse Insurance, Pet Insurance, Critical Illness coverage, ID Protection, etc.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed