Job Description Summary
Performs advanced provider data management activities that support the accuracy, completeness, and integrity of provider and network information across enterprise systems. Processes provider data transactions, validates information, resolves non-routine data discrepancies, and maintains provider records while following established operational procedures, regulatory requirements, and department standards. Partners with Contracting, Credentialing, Provider Relations, and other internal teams to support accurate provider data used for network operations, provider directories, claims processing, and regulatory reporting.
The Network Data Management Specialist III works independently with limited supervision and is routinely relied upon to resolve non-routine operational issues, support process improvement efforts, and provide guidance to peers. Decisions impact team output, data quality, and operational effectiveness within the provider data management function.
How will you make an impact & Requirements
KEY RESPONSIBILITIES
- Process provider data transactions by entering, updating, validating, and maintaining provider and network information across multiple provider data management systems.
- Review provider demographic, contractual, credentialing, and network participation information for accuracy and completeness, resolving non-routine discrepancies using established procedures.
- Perform provider data quality reviews and validation activities to support accurate provider directories, claims processing, regulatory reporting, and operational processes.
- Research provider data discrepancies and coordinate corrections with Contracting, Credentialing, Provider Relations, and other internal departments following established workflows.
- Maintain provider data documentation, processing records, and operational reference materials in accordance with departmental procedures and quality standards.
- Provide day-to-day guidance to team members on provider data entry procedures, system navigation, and established work processes while serving as a resource for routine operational questions.
- Identify operational issues and recommend improvements that increase provider data accuracy, processing efficiency, and consistency.
QUALIFICATIONS
- Associate's degree or bachelor's degree preferred; high school diploma or equivalent with relevant experience may also be considered
- 3+ years of provider data management, managed care, healthcare operations, or related experience.
- Working knowledge of provider data management processes, provider directory maintenance, and healthcare network operations.
- Demonstrated experience performing provider data entry, validation, reconciliation, and maintenance within provider data management systems.
- Excellent attention to detail with the ability to accurately process large volumes of provider data while following established operational procedures and complex work processes.
- Strong written and verbal communication skills and the ability to collaborate effectively with internal stakeholders.
- Proficiency with Microsoft Office applications and provider data management systems; experience with reporting tools or data validation applications preferred.
Compensation Range:
$26.40
to
$39.60
The anticipated base salary range represents the Company's good-faith estimate of the compensation it reasonably expects to pay for this position at the time of posting. Actual compensation will be determined based on factors including experience, skills, qualifications, geographic location, internal equity, and business needs.