Provider Data Management Specialist

Health New England; Springfield (MA); On-site; USD 50,000 - 80,000; Full time

Job summary

An established industry player is seeking a Provider Data Management Specialist to oversee the installation and maintenance of provider data systems. This role ensures data accuracy for enrollment and claims processing while acting as a liaison with vendors and healthcare organizations. The ideal candidate will possess strong problem-solving and communication skills, with a solid background in data management within the healthcare sector. Join a dynamic team where your contributions will enhance provider and member satisfaction in a supportive office environment.

Qualifications

• 4+ years' experience in data maintenance within a relational database.
• Experience in healthcare insurance or vendor organization preferred.

Responsibilities

• Configure and manage provider data in the Amisys database.
• Support department and portal access, project management.
• Manage provider directory data.

Skills

Adaptability

Follow-through

Organization

Problem-solving

Communication

Customer Service

Microsoft Office

Education

Associates Degree

Tools

Amisys

Job description

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Summary:

The Provider Data Management Specialist is responsible for installation and ongoing maintenance of provider data systems at Health New England. Responsibilities include validating provider information for enrollment, claims processing, PCP selection, and managing provider directories and online search results to ensure provider and member satisfaction. The role acts as a liaison for vendors, PHOs, and large groups, handling data evaluation and loading in various systems, identifying configuration needs, auditing data for accuracy and compliance with standards such as DOI, CMS, HEDIS, HIPAA, and NCQA. The specialist supports secure online portals, manages user access, and ensures data confidentiality.

Essential Functions:

1. Configure and manage provider data in the Amisys database (50%)
2. Support department and portal access, project management (25%)
3. Manage provider directory data (25%)

Minimum Requirements:

• Associates degree plus 4+ years' experience in data maintenance within a relational database, healthcare insurance, or vendor organization, or equivalent education and experience.
• Preferred: healthcare network experience, Amisys knowledge.
• Skills: adaptability, follow-through, organization, problem-solving, communication, proficiency in Microsoft Office, customer service.

Working Conditions:

Standard office environment.

Seniority Level:

Mid-Senior level

Employment Type:

Full-time

Job Function:

Information Technology

Industry:

Insurance