Provider Data Specialist_NO

1. About Our Client:

The organization is a national administrator in managed vision care, serving millions of members across the United States. It focuses on facilitating eye health and vision services through a large network of ophthalmology and optometric practitioners. The organization manages extensive provider networks to support vision care delivery and claims processing.

2. About the Opportunity:

The Provider Data Specialist role is responsible for maintaining accurate provider data across multiple databases to ensure proper claims processing, utilization management, and provider directory accuracy. This position plays a critical role in managing provider and payee information, supporting network integrity, and facilitating communication between providers and internal teams.

3. Responsibilities:

• • Manage creation, updates, and terminations of provider, office, and payee data in provider databases
• • Perform audits and maintain data accuracy using external sources such as NPI Registry and state Medicaid files
• • Oversee data for contracted and non-contracted providers to facilitate accurate claims and authorizations
• • Manage complex provider group data and claims-related queues
• • Ensure compliance with IRS standards for payee information and resolve tax submissions
• • Support accounts receivable with provider education on account statuses
• • Educate providers and internal departments on data importance and integrity
• • Process updates received from provider directory vendors
• • Participate in provider data quality improvement initiatives and IT projects
• • Contact providers to validate required data elements
• • Conduct peer review audits to improve processes and data quality

4. Requirements:

• • Four to five years of experience in managed care in roles related to provider data management, credentialing, network management, or provider relations
• • Associate or Bachelor’s degree preferred
• • Experience handling Protected Health Information (PHI) and sensitive data with discretion
• • Knowledge of CMS Provider Directory regulations
• • Proficiency in Microsoft Office applications including Excel, Word, Access, and PowerPoint

5. Pay Range and Compensation Package:

• The pay range and compensation package for this role will be determined based on the candidate’s experience, skills, and other relevant factors.

6. Benefits & Perks:

• • Medical and dental insurance
• • 401(k) plan with company match
• • Tuition reimbursement
• • Vision insurance for employees and qualified dependents

Equal Opportunity Statement: Our client is an equal opportunity employer. They celebrate diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, or national origin.

Note:

RemoteHunter is not the Employer of Record (EOR) for this role. Our purpose in this opportunity is to connect exceptional candidates with leading employers. We help job seekers worldwide discover roles that match their goals and guide them to complete their full application directly through the hiring company’s career page or ATS.