Senior Provider Data and Network Integrity Specialist

CareMore Health; Northern (KY); Hybrid; USD 36,000 - 55,000; Full time

Job summary

CareMore Health is seeking an experienced Network Data Management Specialist III in Kentucky to ensure the accuracy and integrity of provider and network information across enterprise systems. You will process data transactions, validate records, and resolve discrepancies while collaborating with Contracting, Credentialing, Provider Relations, and other internal teams.

In this role, you will independently handle non-routine issues, support process improvements, and guide peers on data entry

Qualifications

• Associate's or Bachelor's degree preferred; HS diploma with relevant experience considered.
• 3+ years of provider data management, managed care, healthcare operations, or related experience.
• Working knowledge of provider data management processes and provider directories.

Responsibilities

• Process provider data transactions by entering, updating, validating, and maintaining provider and network information across multiple provider data management systems.
• Review provider demographic, contractual, credentialing, and network participation information for accuracy and completeness, resolving non-routine discrepancies using established procedures.
• Perform provider data quality reviews and validation activities to support accurate provider directories, claims processing, regulatory reporting, and operational processes.
• Research provider data discrepancies and coordinate corrections with internal teams following established workflows.
• Maintain provider data documentation, processing records, and operational reference materials in accordance with procedures and quality standards.
• Provide day-to-day guidance to team members on provider data entry procedures, system navigation, and established work processes.
• Identify operational issues and recommend improvements to increase provider data accuracy and processing efficiency.

Skills

Provider data management

Provider directory maintenance

Healthcare network operations

Attention to detail

Microsoft Office

Education

Associate's degree or Bachelor's degree preferred

High school diploma or equivalent with related experience

Tools

Provider data management systems

Reporting tools

Data validation applications

Job description

CareMore Health is seeking an experienced Network Data Management Specialist III in Kentucky to ensure the accuracy and integrity of provider and network information across enterprise systems. You will process data transactions, validate records, and resolve discrepancies while collaborating with Contracting, Credentialing, Provider Relations, and other internal teams.

In this role, you will independently handle non-routine issues, support process improvements, and guide peers on data entry