Provider Data Management Specialist- Enrollment
This role focuses on maintaining accurate provider records in healthcare systems while ensuring compliance with CMS, HIPAA, and state regulations through validation, audits, and data reconciliation. The position requires meticulous attention to detail and the ability to independently manage workflows while meeting performance targets.
Skills required
About this role
- Accurately enter, update, and maintain provider information in internal systems
- Validate provider credentialing data, contracts, and demographic data to ensure accuracy
- Ensure provider records are in compliance with CMS, HIPAA, and state/federal regulations
- Conduct routine audits and reconciliations to maintain data integrity.
- Review and load the required data into the health plan system as the process guidelines require
- Manage and monitor daily activities and meet the set targets
- Work independently and complete the tasks in established timeframe with minimal supervision
- Must be able to prioritize and complete all job duty requirements
- Must be able to adhere to changes based on department and/or business
Qualifications
- Excellent written communication skills in English with strong clarity and accuracy
- Strong reading and listening comprehension skills in English to effectively process the requests
- Well-developed analytical, logical, and organizational abilities for problem-solving
- Ability to prioritize tasks effectively, ensuring timely and accurate processing of intakes
- Keen attention to detail with the capability to multitask in a fast-paced environment
- Strong customer focus, with a passion for delivering exceptional service and support
- Proficiency in Microsoft Office Suite and experience navigating web-based applications
- Typing speed of at least 40 words per minute, with accuracy and efficiency
- Excellent internet connectivity, Hard-Wired
- Productive and secure work environment, distraction-free.
Additional Information
All your information will be kept confidential according to EEO guidelines.
EEOC and Veteran Documentation
During employment, employees are treated without regard to race, color, religion, sex, national origin, age, marital or veteran status, medical condition or handicap, or any other legally protected status.
At times, government agencies require periodic reports from employers on the sex, ethnicity, handicap, veteran and other protected status of employees. The purpose of this Administrative EEO Record is for statistical analysis only and is used to comply with government record keeping, reporting, and other legal requirements. Periodic reports are made to the government on the following information. The completion of the Administrative EEO record is optional. If you choose to volunteer the requested information, please note that all
Administrative EEO Records are kept in a Confidential File and are not part of your Application for Employment or Personnel file.
Please note: YOUR COOPERATION IS VOLUNTARY. INCLUSION OR EXCLUSION OF ANY DATA WILL NOT AFFECT ANY EMPLOYMENT DECISION.
