Provider Data Quality & Analytics Specialist

30030 Health Services for Children with Special Needs, Inc.; United States; On-site; USD 54,683 - 91,145; Full time

Job summary

30030 Health Services for Children with Special Needs, Inc. is seeking a Provider Data Specialist to manage and ensure the quality of provider demographic information within health plan systems. This role involves critical oversight of provider directories and implementing quality assurance processes to streamline operations.

The ideal candidate should have at least three years of experience in a managed care or health care setting, with a strong understanding of provider data and health plan operations. A High School diploma is required, while a bachelor's degree in a related field is preferred.

Skills in Microsoft Office software and analytical problem-solving are essential.

Qualifications

• Minimum of three years experience working in managed care or health care setting.
• Experience with provider and health plan data sets.
• Knowledge of claims and provider demographic data sets.

Responsibilities

• Manage the provider add/change process and ensure accurate entry.
• Develop and conduct quality assurance processes.
• Lead audit processes related to provider data.

Skills

Analytical skills

Provider relationship management

Data quality processes

Public presentation skills

Negotiation skills

Education

High School Diploma or GED

Bachelor's Degree in Business, Health Care Management, or related fields

Tools

Microsoft Excel

Microsoft Word

SQL

Job description

30030 Health Services for Children with Special Needs, Inc. is seeking a Provider Data Specialist to manage and ensure the quality of provider demographic information within health plan systems. This role involves critical oversight of provider directories and implementing quality assurance processes to streamline operations.

The ideal candidate should have at least three years of experience in a managed care or health care setting, with a strong understanding of provider data and health plan operations. A High School diploma is required, while a bachelor's degree in a related field is preferred.

Skills in Microsoft Office software and analytical problem-solving are essential.