BusinessOperations - Provider Data Management Analyst 1 - 111458

Position Purpose: Perform provider data management related activities based on plan and contract specifications and standard business rules includes data analysis and entry, review of data via internet sites and other systems, and usage of multiple systems and applications to validate data is complete and accurate.

Education/Experience: Associate s degree, or high school diploma/equivalent and 1+ years of data entry, analysis or customer service experience, preferably with healthcare operations (i.e. claims processing, billing, provider relations or contracting), provider data management, or credentialing in a managed care, insurance, or medical office environment. Experience performing data analysis in Excel or similar tools strongly preferred.

" Enroll providers and practitioners into the provider data management system
" Update provider and practitioners with claims payment and directory information
" Research, review, and make updates within the provider data management system per provider requests
" Perform quality service checks on systemic data, inclusive of claims processing and provider directory information
" Perform research and resolve problems as necessary

EEO:

Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans.

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Position Purpose: Perform provider data management related activities based on plan and contract specifications and standard business rules includes data analysis and entry, review of data via internet sites and other systems, and usage of multiple systems and applications to validate data is complete and accurate. Education/Experience: Associate s degree, or high school diploma/equivalent and 1+ years of data entry, analysis or customer service experience, preferably with healthcare operations (i.e. claims processing, billing, provider relations or contracting), provider data management, or credentialing in a managed care, insurance, or medical office environment. Experience performing data analysis in Excel or similar tools strongly preferred. " Enroll providers and practitioners into the provider data management system " Update provider and practitioners with claims payment and directory information " Research, review, and make updates within the provider data management system per provider requests " Perform quality service checks on systemic data, inclusive of claims processing and provider directory information " Perform research and resolve problems as necessary
Story Behind the Need
The Provider Data Management team is responsible for maintaining accurate and timely provider information across health plan systems. The team processes provider additions, demographic updates, affiliations, terminations, and other provider data changes. We also research discrepancies, validate supporting documentation, and help ensure provider information is accurate for operational and member-facing needs . This position is needed to support current staffing and workload needs within Provider Data Management. Maintaining appropriate staffing is important to manage incoming inventory, meet turnaround expectations, and ensure provider data requests are completed accurately and timely. The team works in a collaborative, detail-focused, and fast-paced environment where accuracy and communication are important. Team members manage individual inventories while also supporting shared priorities and assisting one another when workload or coverage needs change. Current work includes: Provider additions, updates, and terminations Provider roster processing and validation Researching provider data discrepancies Reviewing required documentation before processing requests Managing inventory and aging requests Supporting multiple lines of business and different processing requirements Identifying system or process issues that may affect provider data Participating in training and cross-training to increase team coverage We are looking for someone who is comfortable researching issues, learning multiple systems, managing priorities, and asking questions when information does not align. This request supports the team's current staffing and operational coverage needs. Additional hiring needs may be evaluated based on future staffing changes, workload, and business needs.
Typical Day in the Role
Walk me through the day-to-day responsibilities and a description of the project (Outside of the Workday JD). What are performance expectations/metrics? What makes this role unique?	A typical day for a Provider Data Management Specialist I include: Reviewing and prioritizing assigned provider data requests and inventory. Researching provider information across multiple systems and supports documents. Processing provider additions, demographic changes, affiliations, terminations, and other provider updates. Validating provider information to ensure requests are complete and accurate before processing. Reviewing rosters and supporting documentation and identifying missing or conflicting information. Documenting research, actions taken, and outcomes clearly within the applicable systems. Communicating with internal business partners when additional information or clarification is required. Monitoring aging inventory and completing requests within established turnaround expectations. Escalating system issues, complex discrepancies, or requests that cannot be resolved through standard processes. Participating in team meetings, training, cross-training, and process discussions. Supporting team priorities and assisting with additional inventory when business needs or coverage changes. The role is a combination of data processing, research, problem-solving, and quality review. Accuracy is especially important because provider data can impact downstream operations and the information available for provider-related business needs. Quality and accuracy: Provider data changes should be completed correctly and supported by the appropriate documentation. Productivity: Assigned inventory should be worked consistently while meeting established production expectations. Turnaround times: Requests should be completed within applicable service and aging expectations. Inventory management: Employees are expected to actively manage assigned work and prevent avoidable aging. Research and validation : Specialists should research discrepancies across available systems and documentation before processing updates. Documentation: Clear notes should explain the research performed, actions taken, and final outcome. Process compliance: Requests should follow the appropriate workflow, including requirements that may differ by line of business. Communication: Missing information, unclear requests, and system or data issues should be communicated and escalated appropriately. The Provider Data Management Specialist I role goes beyond traditional data entry. Team members must understand the information they are reviewing, identify when something does not align, and determine when additional research or clarification is needed before making a change. The role provides exposure to: Multiple health plan products and provider networks. Provider additions, updates, affiliations, and terminations. Provider rosters and supporting documentation. Research across multiple provider data systems. Complex provider relationships involving groups, locations, and network participation. Cross-training opportunities that allow employees to expand their knowledge of different processes and lines of business. This is a strong role for someone who enjoys investigating issues and solving problems while still working in a structured, production-focused environment. Accuracy matters because a seemingly small provider data change can affect other business processes. What makes this role especially rewarding is: What makes this role especially rewarding is the opportunity to make a direct impact on the accuracy of provider information while developing strong healthcare operations knowledge. Team members gain experience researching complex provider data, solving discrepancies, learning multiple systems and processes, and collaborating with business partners to ensure provider information is accurate and complete.
Candidate Requirements: Seeking a strong, analytical Business Analyst II who can quickly learn complex processes, independently analyze data, identify root causes and process gaps, and drive issues through resolution. Looking for someone who is highly detail-oriented, solutions-focused, comfortable working with large datasets and reporting tools, and able to effectively communicate findings and recommendations to both business and technical stakeholders. Healthcare/provider data experience is a plus.
Required: High school diploma or equivalent. Relevant healthcare or provider data experience may be considered in place of higher education, depending on company requirements. Certifications: No specific professional certification is necessary for the role unless required by the official job profile.			Preferred: Associate or bachelor s degree in healthcare administration, business administration, health information management, or a related field.
Required:			Preferred:
Years of experience required: 1 2 years of related experience preferred in healthcare operations, provider data, data entry, provider services, credentialing, claims, or another detail-focused administrative environment. Candidates with strong transferable skills and the ability to learn provider data processes may also be considered. Disqualifiers: Poor attention to detail or difficulty maintaining data accuracy. Unable to manage multiple assignments and priorities. Limited ability to research discrepancies and work through problems independently. Difficulty following documented processes and instructions. Poor written communication or incomplete documentation habits. Unwillingness to learn multiple systems, processes, or lines of business. Consistently needing direction rather than taking ownership of assigned work. Additional qualities to look for: Strong research skills and naturally asks questions when information does not match. Detail-oriented and focused on getting the request right, not just completed quickly. Comfortable working in multiple systems and comparing information across different sources. Strong organizational and inventory-management skills. Able to recognize incomplete or conflicting information before processing a request. Willing to learn and receptive to coaching and feedback. Dependable and accountable for assigned work. Strong problem-solving and critical-thinking skills. Able to work independently while still collaborating with the team. Healthcare or provider-data knowledge is a plus, but curiosity, accuracy, and the ability to learn are especially important.
Top 3 must-have hard skills stack-ranked by importance	1	Xcel, systems savvy etc.
	2	quickly learn complex processes
	3	identify root causes and process gaps, and drive issues through resolution
Candidate Review & Selection
Shortlisting process Candidate review & selection Interview information Onboard process and expectations	Projected Manager Candidate Review Date:			1-2 days post shortlisting
	Type of Interviews:			Teams, phone, etc.
	Required Testing or Assessment (by Vendor):			Typing test, basic computers skills test, etc.