Healthcare Data Integrity & Configuration Lead

Provider Network Solutions, LLC; Miami, Northern (FL, KY); Hybrid; USD 90,000 - 130,000; Full time

Job summary

Provider Network Solutions, LLC in Miami, FL is looking for a Configuration and Data Integrity Manager to lead the configuration of benefits, provider records, and network relationships. The role focuses on secure data exchanges, integrity, and availability across claims, eligibility, and provider databases, with collaboration across multiple internal teams.

The candidate will guide data governance, perform audits, and support system configurations for contracts and rate loading while ensuring

Qualifications

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

Responsibilities

• Configure and test benefit configuration and copay/deductible settings in the TPA system.
• Load and manage provider records, contracts, locations, networks and rates; coordinate with Provider Relations and Credentialing.
• Perform unit testing for product upgrades or new releases and ensure designs meet specifications.
• Interpret contracts and business requirements to configuration parameters; ensure data integrity and quality control of provider data, fee schedules and network assignments.
• Collaborate with provider call center, clinical and claims departments to verify provider configurations.
• Provide system configuration support based on changing business needs and review changes to processes.

Skills

Outlook

Excel

Access

Word

Job description

Provider Network Solutions, LLC in Miami, FL is looking for a Configuration and Data Integrity Manager to lead the configuration of benefits, provider records, and network relationships. The role focuses on secure data exchanges, integrity, and availability across claims, eligibility, and provider databases, with collaboration across multiple internal teams.

The candidate will guide data governance, perform audits, and support system configurations for contracts and rate loading while ensuring