Provider Data Quality Analyst

30030 Health Services for Children with Special Needs, Inc.; United States; On-site; USD 55,000 - 91,000; Full time

Job summary

Health Services for Children with Special Needs, Inc. (HSCSN) in Washington, DC seeks a Provider Data Specialist to manage provider demographic data across core health plan systems, including credentialing, claims, and network directories.

The role requires 3+ years in managed care or healthcare data environments, strong data quality skills, and proficiency in Word, Excel, Access, Visio, with SQL knowledge highly desirable. Excellent organizational and communication skills are essential.

Qualifications

• Three years of experience in managed care or healthcare settings.
• Experience with provider and health plan data sets required.
• Knowledge of claims, provider networks, and data identifiers.
• Knowledge of Medicaid and NCQA/HEDIS requirements.
• Proficient in Word, Excel, Access, Visio; SQL desirable.

Responsibilities

• Manages provider add/change and updates provider demographic data.
• Ensures accurate entry of provider data.
• Develops tracking reporting and metrics for provider data.
• Supports regulatory reporting related to provider add/change activity.
• Develops QA processes and quality reviews.
• Analyzes provider data quality across health plan systems.
• Leads audits with the Provider Network Team.
• Supports roster update processes from provider delegates.
• Supports provider data strategies and automation initiatives.
• Ensures loading of provider demographics for contracts.

Skills

SQL

Microsoft Word

Microsoft Excel

Microsoft Access

Microsoft Visio

Education

Bachelor's degree in Business/Health Care

Tools

QNXT

Guiding Care

Job description

Health Services for Children with Special Needs, Inc. (HSCSN) in Washington, DC seeks a Provider Data Specialist to manage provider demographic data across core health plan systems, including credentialing, claims, and network directories.

The role requires 3+ years in managed care or healthcare data environments, strong data quality skills, and proficiency in Word, Excel, Access, Visio, with SQL knowledge highly desirable. Excellent organizational and communication skills are essential.