Provider Data Representative
Job Title: Provider Data RepresentativeLocation: Remote (Only EST & CST time zones candidates are being considered)Duration: 6+ Months with possible extensionPosition SummaryThe 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.Key Outcomes & Success MetricsDirectory 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.QualificationsRequiredBachelor’s degree preferred.2–5 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.PreferredExperience 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.Skills & CompetenciesData governance and quality management.Analytical thinking and problem solving.Process improvement mindset.Attention to detail.Strong written and verbal communication.Collaboration and teamwork.Reporting RelationshipReports to Provider Data Supervisor.