Provider Data Integrity Specialist

JOB SUMMARY: Manage the development and analysis of the quality and accuracy of provider data. Survey and report against provider data standards for database integrity to ensure the quality of provider file information in support of accurate claims payments and provider directories. Ensure adherence to internal and external standards. Develop action plans to improve provider data accuracy based on analysis completed. Act as back up for critical provider data functions including but not limited to provider file extracts and the provider credentialing process.        ESSENTIAL JOB FUNCTIONS: Review and measure the quality of all data in the provider databases through coordination of ongoing quality analysis, verification, and analytical audit activities.Provide ongoing quality control audits and verifications to ensure accuracy and security of data stored in databases. Survey and report against provider data standards for database integrity to ensure the quality of provider file information in support of accurate claims payments and provider directories. Ensure adherence to internal and external standards.Serve as back up to distribute provide files to support organizational areas in accordance with established timeframes and criteria. Serve as back up for the provider Credentialing oversight and completion of administrative tasks associated with the Credentialing process. Liaison with provider practices for roster review. Develop and send communication to providers related to provider data accuracy. Manage all provider data outreach activity for tracking and follow up for non-responsiveness.  Liaison with the Provider data management vendor to develop self-service reporting as applicable. Perform other duties as assigned.   QUALIFICATIONS: Minimum Education and Experience: Bachelor’s degree in Health Services Administration, Computer Science, Information Technology, or related field, or an equivalent combination of education and experience. Three to five years’ experience in a health care field Preferred Education, Additional Qualifications and Experience: Knowledge of Facets claims processing systemsKnowledge of credentialing and provider database operationsKnowledge of provider enrollment processes Required Knowledge, Skills, and/or Abilities: Proficiency with Microsoft Suite of products; i.e., Word, Excel, PPT, etcStrategic and critical thinking skillsStrong analytical skillsStrong written and verbal communication skillsStrong problem solving skillsAbility to work effectively with a wide variety of people in individual and group settingsStrong organizing skills, with the ability to prioritize and respond to shifting deadlinesStrong time management skillsAbility to manage diverse and deadline-oriented workflow

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