Provider Data Management Associate III - Healthcare

UST USource; Pateros; On-site; PHP 500,000 - 750,000; Full time

Job summary

UST USource is seeking a Provider Data Management Analyst to review, validate, and maintain accurate provider information within our BPM environment in Manila. You will support outreach verification, returned mail handling, credentialing record updates, and PIMS claim-related setup, while meeting quality, productivity, and SLA targets.

The successful candidate will have a bachelor’s degree and at least three years of US healthcare provider data management experience, with strong documentation

Qualifications

• Knowledge of US healthcare payer provider data management, credentialing, or provider operations.
• Understanding of provider demographics, specialties, affiliations, practice locations, NPI information, and credential records.
• Familiarity with CAQH, NPPES, state licensing sources, OIG, and NPDB, as applicable.
• High attention to detail and strong documentation accuracy.
• Effective provider outreach, analytical, problem-solving, and escalation skills.
• Ability to work within high-volume queues and SLA-driven BPM operations.
• Understanding of BPM processes, workflow adherence, quality standards, and productivity metrics.

Responsibilities

• Review and update provider demographics, addresses, specialties, affiliations, practice locations, and related provider records.
• Validate and update provider information according to approved BPM workflows and procedures.
• Retain provider correspondence, notes, records, and supporting evidence.
• Identify incomplete or conflicting information and follow escalation procedures.
• Support outreach verification and returned mail processes with proper documentation.
• Review credentialing records and support recredentialing activities and compliance checks.
• Research and load missing provider data into claims systems to enable downstream processing.
• Update trackers, dashboards, and status records; support quality and SLA reporting.

Education

Bachelor's degree

3+ years experience in US healthcare provider data management

Job description

The Provider Data Management (PDM) Analyst is responsible for reviewing, validating, updating, and maintaining accurate provider information within a Business Process Management (BPM) environment according to approved Premera processes and procedures. The role supports outreach verification, returned mail, credentialing record updates, and PIMS claim-related provider setup while meeting quality, productivity, documentation, turnaround-time, and SLA requirements.

Key Responsibilities

Provider Data Review & Maintenance

• Review provider update requests from preferred and non-preferred providers
• Validate and update provider demographics, addresses, specialties, affiliations, practice locations, and related provider records
• Retain provider correspondence, telephone notes, system records, and supporting evidence
• Identify incomplete, inconsistent, or conflicting information and follow established escalation procedures
• Perform activities in accordance with defined BPM workflows, process controls, and operational guidelines

Outreach Verification

• Contact providers by email or telephone when needed to confirm the accuracy of requested updates
• Document outreach attempts, responses, and final validation outcomes
• Complete outbound calls for cases requiring verbal confirmation
• Ensure updates are supported by appropriate evidence before closure

Returned Mail

• Review returned mail cases when the postal service cannot identify a valid addressee or delivery address
• Validate provider address information using approved procedures and sources
• Update applicable systems and retain supporting evidence
• Escalate unresolved discrepancies or potential network-access concerns

Credentialing Record Updates

• Review records returned by the credentialing vendor
• Complete credentialing record updates according to approved policies and procedures
• Validate required documentation and identify missing or inconsistent information
• Support recredentialing activities including application review, expirable monitoring, primary source verification, and compliance checks when assigned

PIMS Claims Support

• Review claims pended because a group or practitioner is not loaded in the claims system
• Research and load missing provider information into the designated provider system according to approved procedures
• Validate that provider information is complete and accurately entered to enable downstream claims processing
• Escalate records that cannot be resolved using available documentation and approved sources

Workflow, Quality & Reporting

• Manage assigned inventory and meet productivity, quality, SLA, and turnaround-time expectations
• Perform self-quality checks and resolve identified defects promptly
• Update trackers, dashboards, case notes, and status records accurately
• Support backlog reduction, aging control, audit requests, and continuous improvement activities
• Participate in BPM quality initiatives, process improvement programs, and operational excellence activities

Mandatory Skills & Competencies

• Knowledge of US healthcare payer provider data management, credentialing, or provider operations
• Understanding of provider demographics, specialties, affiliations, practice locations, NPI information, and credential records
• Familiarity with CAQH, NPPES, state licensing sources, OIG, and NPDB, as applicable
• High attention to detail and strong documentation accuracy
• Effective provider outreach, analytical, problem-solving, and escalation skills
• Ability to work within high-volume queues and SLA-driven BPM operations
• Understanding of BPM processes, workflow adherence, quality standards, and productivity metrics

Qualifications

Education

• Bachelor's degree

Experience

• Min of 3 years in US healthcare provider data management, credentialing, recredentialing, or provider operations
• Experience in healthcare payer or BPO/BPM operations preferred