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 to oversee claims processing, provider configuration, and data integrity across the organization. The role focuses on secure data exchanges, database administration, and collaboration with internal departments and health plans.

The position involves interpreting contracts, loading rate data, testing configurations, and ensuring accurate provider information.

Qualifications

• 3-5 years of Claims Processing experience required.
• 1-2 years' experience in healthcare data management.
• Broad knowledge of medical terminology, customer service, claims processing and/or cost containment, coordination of benefits and diagnosis coding.

Responsibilities

• Implement and oversee benefit configuration, provider data management, and contracts in the TPA system.
• Conduct unit testing and validate configuration against requirements for upgrades or releases.
• Review and interpret contracts to convert terms into configuration parameters.
• Ensure data integrity of provider data, fee schedules, network assignment, and related information.

Skills

Microsoft Office

Tools

TPA System

Job description

Provider Network Solutions LLC is seeking a Configuration and Data Integrity Manager to oversee claims processing, provider configuration, and data integrity across the organization. The role focuses on secure data exchanges, database administration, and collaboration with internal departments and health plans.

The position involves interpreting contracts, loading rate data, testing configurations, and ensuring accurate provider information.