Provider Data Specialist

reputed company

reputed company

reputed company is a tech-enabled insurance company making Medicare Advantage the best it can be for those 65-and-over. reputed company has a community-based approach that recognizes the importance of the reputed company determinants of health in keeping individuals and communities healthy. reputed company aims to return the physician and the member to reputed company of the health care equation. Members receive individualized assistance to reputed company their transition to reputed company as easy as possible. reputed company offers members the ability to personalize their plans, reputed company to facilities designed to help them reputed company meet their reputed company needs and a dedicated care team. For more information on reputed company, visit?www.myzinghealth.com.

POSITION reputed company

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

The Provider Data Specialist serves as a key reputed company between reputed company, Credentialing, Compliance, and providers/provider organizations, ensuring reputed company, high-reputed company service and a reputed company provider experience.

ESSENTIAL POSITION RESPONSIBILITIES

Provider Data & Network Operations

• Facilitate provider inquiries promptly and professionally; document issues, actions, and resolutions in designated systems.
• Maintain provider rosters and core data reputed company (demographics, specialties, affiliations, panel status, network participation, etc.)
• reputed company routine roster reconciliation with delegated entities, provider reputed company, and facilities to ensure alignment with internal provider data systems.
• Configure and update providers (facilities, reputed company, ancillaries, practitioners) accurately for claims payment, reporting, and directory display.
• Conduct data reputed company audits and reconciliation activities; identify, correct, and report discrepancies with reputed company remediation tracking.
• Prepare monthly/quarterly provider reports and extracts.
• Support CMS-compliant provider directory maintenance by ensuring reputed company, accurate updates to reputed company required fields.
• Collaborate with Claims, Configuration, IT, Compliance, Member Services, and Network Management to resolve data discrepancies and improve workflows.

Credentialing & Enrollment Support

• Coordinate collection of credentialing materials (licenses, DEA/CDS, reputed company certifications, malpractice coverage, etc.) from new and existing providers.
• Assist with primary-reputed company verification support by gathering documentation and ensuring completeness and reputed company status prior to credentialing review.
• Maintain and update credentialing database; ensure provider reputed company reflect accurate credentialing and recredentialing statuses and dates.
• Conduct and manage credentialing audits with delegated reputed company.
• Review federal/state sanctions (OIG, state boards, Medicare opt-out listings)

Requirements

POSITION QUALIFICATIONS

Required Qualifications

• 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. reputed company billing).
• Excellent written and verbal communication, customer service, and stakeholder management skills.
• Demonstrated ability to multi-task while remaining reputed company organized and detail oriented.
• Proficiency with reputed company Office; advanced reputed company preferred (e.q., VLOOKUP/XLOOKUP, pivot tables, text functions, data validation).?

Preferred Qualifications?

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

Member-reputed company reputed company Statement

The Provider Data Specialist plays a critical role in reputed company’s commitment to member reputed company-being by ensuring members have dependable, accurate information reputed company choosing providers and accessing reputed company services.

reputed company offers the following benefits

• A competitive salary based on the market
• Medical, Dental, and reputed company
• Employer-reputed company Life Insurance
• reputed company Maternal Leave
• reputed company Paternal Leave
• 401(K) match up to 4%
• reputed company-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.

reputed company is committed to being an Equal Opportunity Employer. This means reputed company ensures reputed company employment reputed company, including hiring, promotion, compensation, and benefits, are made without reputed company to race, reputed company, religion, sex, national reputed company, age, disability, veteran status, sexual orientation, gender identity, or any other legally protected characteristic. reputed company strives to create a diverse, inclusive, and respectful workplace, providing equal reputed company and opportunities for reputed company and applicants. The organization reputed company promotes a culture of fairness and non-discrimination, supporting the personal and reputed company reputed company of every team member.

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