Provider Data Specialist - Hybrid (Regulatory & Quality)

BrightonOne; Boston (MA); Hybrid; USD 65,000 - 90,000; Full time

Job summary

BrightonOne is seeking a Provider Data Specialist to manage and validate provider and facility data within the USFHP network. You will ensure regulatory compliance, support directory accuracy, and collaborate across multiple teams to maintain data integrity and service quality for members and providers.

The role focuses on data quality assurance, onboarding coordination, and ad hoc reporting, with a hybrid work arrangement in the Brighton, MA area and access to secure health information systems.

Qualifications

• Associate degree or equivalent experience in health data.
• 2+ years in provider data management or related healthcare operations.
• Experience with Medicare, TRICARE, or government programs preferred.
• Advanced Excel skills including pivot tables, VLOOKUP/XLOOKUP, and data validation.

Responsibilities

• Maintain provider demographic, contractual, credentialing, and practice location information in provider databases and health plan systems.
• Validate and audit provider records to ensure data completeness, accuracy, and consistency across systems.
• Support provider directory accuracy initiatives and regulatory audits and reporting.
• Collaborate with Provider Relations, Credentialing, and Claims teams on onboarding, updates, and issue resolution.
• Generate routine and ad hoc reports and monitor KPIs for data quality and timeliness.

Skills

Advanced Excel

Data analysis

Attention to detail

Communication skills

Problem solving

Education

Associate degree or equivalent in health data or related field

Tools

Facets

QNXT

HealthRules

CAQH

NPPES

Job description

BrightonOne is seeking a Provider Data Specialist to manage and validate provider and facility data within the USFHP network. You will ensure regulatory compliance, support directory accuracy, and collaborate across multiple teams to maintain data integrity and service quality for members and providers.

The role focuses on data quality assurance, onboarding coordination, and ad hoc reporting, with a hybrid work arrangement in the Brighton, MA area and access to secure health information systems.