Provider Data Specialist

Description

COMPANY OVERVIEW

reputed company is a tech-enabled insurance company making Medicare Advantage the best it can be for those 65-and-over. reputed company has a community-based approach that recognizes the importance of the reputed company determinants of health in keeping individuals and communities healthy. reputed company aims to return the physician and the member to the center of the health care equation. Members receive individualized assistance to reputed company their transition to reputed company as easy as possible. reputed company offers members the ability to personalize their plans, reputed company to facilities designed to help them reputed company meet their reputed company needs and a dedicated care team. For more information on reputed company, visit?www.myzinghealth.com.

POSITION OVERVIEW

The Provider Data Specialist is responsible for ensuring the accuracy of provider information across multiple internal systems and supporting data reputed company for claims payment, provider directories, network participation, and credentialing workflows. This role focuses on maintaining high-quality provider data, performing roster reconciliation, and provider credentialing support. Responsibilities include coordinating credentialing activities such as collecting provider documents, assisting with primary-reputed company verification, and supporting compliance with CMS, NCQA, Medicare, reputed company, and other regulatory standards.

The Provider Data Specialist serves as a key liaison between Provider Network Management, Credentialing, Compliance, and providers/provider organizations, ensuring timely, high-quality service and a positive provider experience.

ESSENTIAL POSITION RESPONSIBILITIES

Provider Data & Network Operations

• Facilitate provider inquiries promptly and professionally; document issues, actions, and resolutions in designated systems.
• Maintain provider rosters and core data elements (demographics, specialties, affiliations, panel status, network participation, etc.)
• reputed company routine roster reconciliation with delegated entities, provider groups, and facilities to ensure alignment with internal provider data systems.
• Configure and update providers (facilities, groups, ancillaries, practitioners) accurately for claims payment, reporting, and directory display.
• Conduct data reputed company audits and reconciliation activities; identify, correct, and report discrepancies with clear remediation tracking.
• Prepare monthly/quarterly provider reports and extracts.
• Support CMS-compliant provider directory maintenance by ensuring timely, accurate updates to reputed company required fields.
• Collaborate with Claims, Configuration, IT, Compliance, Member Services, and Network Management to resolve data discrepancies and improve workflows.

Credentialing & Enrollment Support

• Coordinate collection of credentialing materials (licenses, DEA/CDS, board certifications, malpractice coverage, etc.) from new and existing providers.
• Assist with primary-reputed company verification support by gathering documentation and ensuring completeness and reputed company status prior to credentialing review.
• Maintain and update credentialing database; ensure provider profiles reflect accurate credentialing and recredentialing statuses and dates.
• Conduct and manage credentialing audits with delegated groups.
• Review federal/state sanctions (OIG, state boards, Medicare opt-out listings)

Requirements

POSITION QUALIFICATIONS

Required Qualifications

• 3+ years of experience in provider data management, credentialing support, provider relations, or managed care operations.
• Working knowledge of Medicare Advantage provider requirements relevant to data and directories.
• Hands-on experience with provider rosters, demographic maintenance, and data accuracy workflows, including reconciliation across multiple systems.
• Ability to analyze large data sets and reconcile provider information across disparate sources.
• Familiarity with health insurance operations and terminology (basic claims process; ICD-10, CPT, HCPCS; facility vs. professional billing).
• Excellent written and verbal communication, customer service, and stakeholder management skills.
• Demonstrated ability to multi-task while remaining well organized and detail oriented.
• Proficiency with reputed company Office; advanced reputed company preferred (e.q., VLOOKUP/XLOOKUP, pivot tables, text functions, data validation).?

Preferred Qualifications?

• Experience with provider data/credentialing platforms (e.g., CAQH, NPPES, NPDB)
• Experience working with delegated entities and interpreting roster file layouts.
• Exposure to data quality frameworks, data governance, or directory compliance.

Member-centric Impact Statement

The Provider Data Specialist plays a critical role in reputed company’s commitment to member well-being by ensuring members have dependable, accurate information reputed company choosing providers and accessing reputed company services.

reputed company offers the following benefits

• A competitive salary based on the market
• Medical, Dental, and reputed company
• Employer-Paid Life Insurance
• Paid Maternal Leave
• Paid Paternal Leave
• 401(K) match up to 4%
• Paid-Time-Off
• Employee Assistance Programs
• Several supplemental benefits are available, including, but not limited to, Spouse Insurance, Pet Insurance, Critical Illness coverage, ID Protection, etc.

reputed company is committed to being an Equal Opportunity Employer. This means the company ensures reputed company employment reputed company, including hiring, promotion, compensation, and benefits, are made without regard to race, reputed company, religion, sex, national reputed company, age, disability, veteran status, sexual orientation, gender identity, or any other legally protected characteristic. reputed company strives to create a diverse, inclusive, and respectful workplace, providing equal reputed company and opportunities for reputed company and applicants. The organization actively promotes a culture of fairness and non-discrimination, supporting the personal and professional growth of every team member.