Provider Data Integrity & Compliance Specialist

Sutherland; Town of Texas (WI); On-site; USD 52,000 - 74,000; Full time

Job summary

Sutherland is seeking a Provider Data Management (PDM) Specialist to oversee and maintain accurate provider records within our health plan systems. This role involves entering and updating provider data and demographic information in internal systems, while ensuring accuracy and compliance with policies and regulations.

The ideal candidate will have strong attention to detail, analytical skills, and experience working with provider networks and healthcare databases.

Qualifications

• Accurately enter, update, and maintain provider information in internal systems.
• Validate credentialing data, contracts, and demographics for accuracy.
• Ensure records comply with CMS, HIPAA, and state/federal regulations.
• Perform routine audits and reconciliations to maintain data integrity.

Responsibilities

• Enter and update provider data in health plan systems.
• Validate data and ensure compliance with policies and regulations.
• Support data audits and reconciliations to ensure integrity.
• Meet daily targets and work independently with minimal supervision.

Skills

Provider data entry

Attention to detail

Analytical skills

English communication

Microsoft Office

Typing 40 wpm

Data integrity

Job description

Sutherland is seeking a Provider Data Management (PDM) Specialist to oversee and maintain accurate provider records within our health plan systems. This role involves entering and updating provider data and demographic information in internal systems, while ensuring accuracy and compliance with policies and regulations.

The ideal candidate will have strong attention to detail, analytical skills, and experience working with provider networks and healthcare databases.