Network Data Management Specialist III

CareMore Health Management Services, LLC; San Francisco (CA); On-site; USD 55,000 - 82,000; Full time

Job summary

CareMore Health Management Services, LLC in San Francisco is seeking an experienced Network Data Management Specialist III to ensure accuracy and integrity of provider and network information across core systems. You will process provider data transactions, validate records, and resolve non-routine discrepancies following established workflows.

The role partners with Contracting, Credentialing, Provider Relations and other teams to support accurate provider directories, claims processing, and

Qualifications

• 3+ years of provider data management, managed care, healthcare operations or related experience.
• Working knowledge of provider data management processes and provider directory maintenance.
• Experience with provider data entry, validation, reconciliation and maintenance within provider data management systems.
• Excellent attention to detail and ability to process large volumes of data following procedures.
• Strong written and verbal communication and collaboration with internal stakeholders.
• Proficiency with Microsoft Office and provider data management systems; reporting tools preferred.

Responsibilities

• Process provider data transactions across multiple systems: enter, update, validate, maintain.
• Review provider demographic, contractual, credentialing, and network information for accuracy and completeness; resolve non-routine discrepancies.
• Perform provider data quality reviews to support accurate directories, claims processing, and regulatory reporting.
• Research discrepancies and coordinate corrections with internal teams following workflows.
• Maintain provider data documentation and processing records per procedures and quality standards.
• Provide day-to-day guidance to peers on data entry procedures and system navigation.

Skills

Provider data management

Healthcare operations

Data quality

Education

Associate's/Bachelor's preferred

Tools

Microsoft Office

Provider data systems

Job description

Job Description Summary

Performs advanced provider data management activities that support the accuracy, completeness, and integrity of provider and network information across enterprise systems. Processes provider data transactions, validates information, resolves non-routine data discrepancies, and maintains provider records while following established operational procedures, regulatory requirements, and department standards. Partners with Contracting, Credentialing, Provider Relations, and other internal teams to support accurate provider data used for network operations, provider directories, claims processing, and regulatory reporting. The Network Data Management Specialist III works independently with limited supervision and is routinely relied upon to resolve non-routine operational issues, support process improvement efforts, and provide guidance to peers. Decisions impact team output, data quality, and operational effectiveness within the provider data management function.

KEY RESPONSIBILITIES

• Process provider data transactions by entering, updating, validating, and maintaining provider and network information across multiple provider data management systems.
• Review provider demographic, contractual, credentialing, and network participation information for accuracy and completeness, resolving non-routine discrepancies using established procedures.
• Perform provider data quality reviews and validation activities to support accurate provider directories, claims processing, regulatory reporting, and operational processes.
• Research provider data discrepancies and coordinate corrections with Contracting, Credentialing, Provider Relations, and other internal departments following established workflows.
• Maintain provider data documentation, processing records, and operational reference materials in accordance with departmental procedures and quality standards.
• Provide day-to-day guidance to team members on provider data entry procedures, system navigation, and established work processes while serving as a resource for routine operational questions.
• Identify operational issues and recommend improvements that increase provider data accuracy, processing efficiency, and consistency.

QUALIFICATIONS

• Associate's degree or bachelor's degree preferred; high school diploma or equivalent with relevant experience may also be considered 3+ years of provider data management, managed care, healthcare operations, or related experience.
• Working knowledge of provider data management processes, provider directory maintenance, and healthcare network operations.
• Demonstrated experience performing provider data entry, validation, reconciliation, and maintenance within provider data management systems.
• Excellent attention to detail with the ability to accurately process large volumes of provider data while following established operational procedures and complex work processes.
• Strong written and verbal communication skills and the ability to collaborate effectively with internal stakeholders.
• Proficiency with Microsoft Office applications and provider data management systems; experience with reporting tools or data validation applications preferred.

Compensation Range: $26.40 to $39.60 The anticipated base salary range represents the Company's good-faith estimate of the compensation it reasonably expects to pay for this position at the time of posting. Actual compensation will be determined based on factors including experience, skills, qualifications, geographic location, internal equity, and business needs.

Mosaic Health is a national care delivery platform focused on expanding access to comprehensive primary care for consumers with coverage across Commercial, Individual Exchange, Medicare, and Medicaid health plans.

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