Provider Data Specialist: Data Integrity & Network Accuracy

Versant Health; City of Troy (NY); On-site; USD 26,000 - 36,000; Full time

Benefits offered by this job

Health insurance

Dental insurance

Tuition reimbursement

401(k) with company match

Pet insurance

Job summary

Versant Health in the United States seeks a Provider Data Specialist to educate, verify, monitor, and manage provider and payee data across two national networks. You will perform additions, changes, and terminations to provider databases to ensure accurate claims processing and authorizations.

You will conduct audits, support data integrity projects, enforce IRS verifications, and collaborate with internal teams to improve data quality.

Qualifications

• 4-5 years of experience with a managed care organization in Provider Data Management, Credentialing, Network Management, or Provider Relations.
• Combination of education and work experience; Associate or Bachelor’s degree preferred.
• Experience handling PHI/PII and confidential information with discretion and trust.
• Experience managing provider, office and payee data and/or claims processing.
• Experience with provider networks and CMS Provider Directory regulations.
• Proficiency with Microsoft Office Excel, Word, Excel, Access, and Power Point.

Responsibilities

• Create or update provider, office, and payee data in three provider databases from contracting/credentialing submissions.
• Review and edit provider data to ensure accurate claims processing and authorizations.
• Terminate provider, office, and payee records using correct codes; review documentation on requests.
• Manage complex provider and group data across databases and update rosters regularly.
• Support provider data audits and data integrity projects with internal teams.
• Contact providers to validate required data elements via phone or email.
• Educate internal departments about provider data and the Provider Directory.

Skills

Data management

Attention to detail

Microsoft Office

Education

Associate or Bachelor’s degree

Tools

Excel

Word

Access

PowerPoint

Job description

Versant Health in the United States seeks a Provider Data Specialist to educate, verify, monitor, and manage provider and payee data across two national networks. You will perform additions, changes, and terminations to provider databases to ensure accurate claims processing and authorizations.

You will conduct audits, support data integrity projects, enforce IRS verifications, and collaborate with internal teams to improve data quality.