Healthcare Data Integrity & Configuration Lead

Provider Network Solutions, LLC; Miami (FL); On-site; USD 90,000 - 120,000; Full time

Job summary

Provider Network Solutions, LLC is seeking a Configuration and Data Integrity Manager in Florida. The role focuses on implementing and interpreting claims, provider configuration, eligibility, and provider database management to ensure secure data exchanges and reliable operations.

The position collaborates with internal departments to coordinate network database systems, conduct audits, and guide data management practices across the organization.

Qualifications

• 3–5 years of claims processing experience.
• 1–2 years of healthcare data management.
• Broad knowledge of medical terminology, customer service, and claims processing.
• Understanding of coordination of benefits and diagnosis coding.

Responsibilities

• Configure provider records, contracts, rates, vendors, and locations.
• Ensure data integrity and accurate benefit configurations in TPA systems.
• Perform unit testing for product upgrades and new releases.
• Interpret contracts and translate requirements into configuration parameters.
• Quality control of information uploaded to the TPA system.
• Collaborate with Provider Relations, Credentialing, and Claims teams.
• Load and maintain fee schedules in the TPA system.
• Review configuration processes and recommend improvements.

Skills

Claims Processing

Healthcare Data Mgmt

Medical Terminology

Customer Service

Coordination of Benefits

Diagnosis Coding

Tools

MS Excel

MS Word

MS Access

Outlook

Job description

Provider Network Solutions, LLC is seeking a Configuration and Data Integrity Manager in Florida. The role focuses on implementing and interpreting claims, provider configuration, eligibility, and provider database management to ensure secure data exchanges and reliable operations.

The position collaborates with internal departments to coordinate network database systems, conduct audits, and guide data management practices across the organization.