Provider Data Governance Lead

Capital Rx; Denver (CO); Hybrid; USD 133,000 - 166,000; Full time

Job summary

Judi Health in Denver hybrid role seeks a Principal, Provider Data Management to serve as enterprise SME and senior steward for provider data, network data, roster, and contracts, ensuring accuracy, governance, and compliant downstream propagation.

You will lead governance, resolve complex data issues, mentor teams, and drive improvements across intake, maintenance, quality, audits, and downstream consumption.

Qualifications

• Bachelor's degree in healthcare administration, business, information systems, analytics, or a related field.
• 7+ years of healthcare provider data, network operations, payer/TPA operations, claims configuration, provider relations, or healthcare data-governance experience.
• Data stewardship, contract-data fluency, claims/network acumen, governance mindset, executive communication, root-cause problem solving, cross-functional leadership.
• Advanced understanding of provider identifiers, provider hierarchies, roster management, contract data, network participation, effective dating, and downstream payer/TPA system impacts.
• Demonstrated ability to govern provider adds/deletes/changes with strong controls, documentation, reconciliation, audit readiness, and issue-resolution discipline.
• Strong knowledge of how provider data impacts claims pricing, repricing, member liability, provider directories, network access, client implementations, reporting, and vendor integrations.
• Advanced Excel/data-analysis skills and comfort working with large datasets, exception reports, data feeds, workflow tools, and operational dashboards.
• Ability to influence senior stakeholders across Network Contracting, Claims, IT, EDI/Data Engineering, Compliance, Legal, Provider Relations, Analytics, Client Implementation, and vendors.

Responsibilities

• Lead enterprise provider-data governance for critical fields.
• Own compliant processes for provider adds, deletes, changes, and terminations.
• Manage roster operations for contracted groups, facilities, ancillaries, direct contracts, COEs, high-performance networks, wrap networks, and other network arrangements.
• Partner with Network Contracting, Product and Engineering teams and Third-Party vendors to translate contract terms, amendments, carve-outs, fee schedules, tiers, and reimbursement indicators into accurate provider data and pricing setup requirements.
• Ensure accurate downstream propagation to claims, repricing, provider directories, member/provider portals, eligibility, care navigation, UM, analytics, stop-loss, client reporting, EDI/data feeds, and external vendors.
• Design and run data-quality controls: completeness checks, duplicate detection, roster reconciliation, effective-date validation, contract-data alignment, exception reporting, and root-cause correction plans.
• Serve as escalation point for high-impact issues involving claims pricing, network assignment, directory accuracy, access-to-care, provider payment, client implementation, or compliance exposure.
• Maintain SOPs, data dictionaries, governance rules, change-control artifacts, intake templates, QA checklists, reconciliation standards, and management reporting.
• Support audits, regulatory readiness, network adequacy/directory accuracy needs, NSA/balance-billing operations, and client commitments by producing defensible documentation and control evidence.
• Mentor analysts/specialists, influence cross-functional operating practices, and lead continuous-improvement initiatives that increase data quality, speed, transparency, and accountability.

Skills

Data governance

Stakeholder influence

Executive communication

Cross-functional leadership

Root-cause analysis

Mentoring

Process improvement

Problem solving

Data analysis

Data stewardship

Governance mindset

Education

Bachelor's degree

Tools

SQL

Excel

Data visualization tools

Job description

Judi Health in Denver hybrid role seeks a Principal, Provider Data Management to serve as enterprise SME and senior steward for provider data, network data, roster, and contracts, ensuring accuracy, governance, and compliant downstream propagation.

You will lead governance, resolve complex data issues, mentor teams, and drive improvements across intake, maintenance, quality, audits, and downstream consumption.