Provider Data & Credentialing Specialist (On-Site)

Sante Health System, Inc.; Fresno (CA); On-site; USD 45,000 - 65,000; Full time

Benefits offered by this job

Medical, dental, vision, and life ins.

401k retirement plan

Paid time off

Opportunities for advancement

Job summary

Santé Health System is seeking a Provider Data Coordinator to join our Fresno, CA team. In this full-time role, you will coordinate provider demographic data, ensure accuracy, and support regulatory requirements within the Provider Credentialing department.

You will work closely with health plans, providers, and internal staff, maintaining databases, generating reports, and assisting with data validation and roster audits. This position requires attention to detail and teamwork.

Qualifications

• High School diploma/GED equivalent required.
• Three years' experience in data analytics to include at least one year of experience in a healthcare setting preferred.
• Experience and working knowledge of clinic operations.
• Proficient user of MS Office Suite primarily Microsoft Excel.
• Working knowledge of managed care environment and associated lines of business such as HMO/Commercial/Medicare/Medicaid.
• Knowledge of database software applications is a plus.

Responsibilities

• Serves as a key liaison between health plans, providers and internal staff to process, review and communicate provider demographic data.
• Maintains provider database and demographic data for health plan rosters/directories, ensuring that data accurately reflects provider participation on various panels.
• Responsible for communicating demographic changes to health plans and internal staff via template report.
• Generates reports, both routine and ad hoc to appropriate staff or delegated groups.
• Assists health plans with quarterly data validation queries.
• Responds to health plan inquiries related to provider demographic data.
• Accountable for optimal usage of the existing data systems and applications.
• Data mining, summarizing, validation and integrity of provider demographic data.
• Responsible for supporting Provider Credentialing initiatives including data entry, roster audits and overall provider roster.
• Actively participate in health plan meetings, serving as the IPA's representative.
• Actively participate in cross-functional projects having an impact on Provider Credentialing.
• In the spirit of teamwork, employees are expected to follow any other job-related instructions and to perform any other job-related duties as requested.

Skills

MS Excel

Data analytics

Communication

Time management

Teamwork

Problem solving

Education

High School Diploma or GED

Tools

MD Staff platform

Provider data systems

Job description

Santé Health System is seeking a Provider Data Coordinator to join our Fresno, CA team. In this full-time role, you will coordinate provider demographic data, ensure accuracy, and support regulatory requirements within the Provider Credentialing department.

You will work closely with health plans, providers, and internal staff, maintaining databases, generating reports, and assisting with data validation and roster audits. This position requires attention to detail and teamwork.