Provider Data Quality Lead

Socket.dev; City of Troy (NY); On-site; USD 29,000 - 33,000; Full time

Job summary

Versant Health is seeking a Provider Data Specialist to educate, verify, monitor, and manage provider, office, and payee data across national networks. You will update records, ensure accuracy for claims processing and authorizations, and conduct audits to support data integrity.

The role requires experience in provider data management within a managed care setting, strong privacy discipline, and familiarity with CMS Provider Directory regulations.

Qualifications

• Four to Five (4-5) years of experience with a managed care organization in a Provider Data Management, Credentialing, Network Management, Network Development, and/or Provider Relations role
• Combination of education and work experience required; Associate or Bachelor’s degree preferred
• Capable and comfortable dealing with Protected Health Information (PHI), Personal Identifiable Information (PII), sensitive, and confidential information with discretion and trust
• Experience must include direct responsibility for managing provider, office and payee data and/or claims processing

Responsibilities

• Create new providers, offices, and payees into provider databases based on contracting and credentialing data
• Review and edit existing provider data to ensure accurate claims processing and authorizations
• Terminate provider, office, and payee records using correct termination codes after reviewing documentation
• Manage provider data across three provider databases and update rosters as needed
• Support provider data education across departments and interact with internal/external customers

Skills

PHI/PII handling

Data management

Provider data

CMS regulations

Education

Associate or Bachelor's degree

Tools

Excel

Word

Access

PowerPoint

Job description

Versant Health is seeking a Provider Data Specialist to educate, verify, monitor, and manage provider, office, and payee data across national networks. You will update records, ensure accuracy for claims processing and authorizations, and conduct audits to support data integrity.

The role requires experience in provider data management within a managed care setting, strong privacy discipline, and familiarity with CMS Provider Directory regulations.