Remote Provider Relations & Data Integrity Specialist

Globalhealth Holdings; Oklahoma City (OK); Hybrid; USD 52,000 - 75,000; Full time

Job summary

GlobalHealth is seeking a provider data QA specialist to ensure accuracy of the provider directory and data integrity across systems. This role supports CMS and NCQA compliance while improving access for Health Plan members in a remote, nationwide setting.

You'll maintain provider/vendor records, respond to inquiries, and collaborate with internal teams to educate providers and uphold HIPAA privacy standards.

Qualifications

• High school diploma or equivalent is required.
• Bachelor's degree preferred.

Responsibilities

• Maintain accurate Provider/Vendor records and Provider Directory.
• Develop and evaluate provider network to ensure access for Health Plan membership.
• Create and verify Provider Data integrity with ongoing monitoring and respond to inquiries.
• Educate and assist providers to maximize data integrity and provider experience.
• Collaborate with internal/external teams to improve network strategies and relations.
• Respond to provider nominations and guide leadership based on network needs.
• Assist with CMS guidelines and NCQA accreditation standards.
• On-board new providers including training to ensure program success.
• Handle Provider Inquiries via emails, CRMs, and surveys in a timely manner.

Skills

Data integrity

Provider relations

HIPAA compliance

Analytical skills

Education

High school diploma

Bachelor's degree preferred

Tools

NPPES data

Job description

GlobalHealth is seeking a provider data QA specialist to ensure accuracy of the provider directory and data integrity across systems. This role supports CMS and NCQA compliance while improving access for Health Plan members in a remote, nationwide setting.

You'll maintain provider/vendor records, respond to inquiries, and collaborate with internal teams to educate providers and uphold HIPAA privacy standards.