Provider Data Integrity Specialist

Description:

JOB SUMMARY

The Provider Data Integrity Specialist is responsible for maintaining accurate provider demographic, participation, and contractual data across organizational systems and health plan reporting platforms. This role supports provider onboarding, roster submissions, provider directory accuracy, and system updates to ensure compliance with regulatory, contractual, and operational requirements. The Specialist works closely with Credentialing, Provider Relations, and Health Plan Operations teams to ensure provider data accuracy and support network operations.

Requirements:

MINIMUM & PREFERRED QUALIFICATIONS

Education/Training Minimum:

High School diploma or equivalent.

Preferred:

Associate's or Bachelor's degree in Healthcare Administration, Business Administration, or related field.

Experience Minimum:

2+ years of provider data management, credentialing, or healthcare administrative experience.

Preferred:

Experience in MSO, IPA, or health plan environment. Any combination of educational and work experience that would be equivalent to the stated minimum requirements would qualify for consideration of this position. Skills, Knowledge & Abilities Knowledge of provider data management and healthcare systems. Proficiency with provider management systems such as EZ Cap, EPIC, or similar. Strong attention to detail and accuracy. Strong organizational and communication skills. Ability to maintain confidentiality and data integrity. Ability to manage multiple tasks and meet deadlines.

PHYSICAL, MENTAL & ENVIRONMENTAL REQUIREMENTS

The physical, mental, and environmental demands described here are representative of those required to successfully perform the essential functions of this job. Work is primarily performed in a standard office or hybrid office environment and requires prolonged periods of sitting, frequent use of computers, telephones, and office equipment. The role requires sustained mental concentration, attention to detail, and the ability to review and verify credentialing documentation accurately. Occasional lifting or moving of materials up to approximately 15-20 pounds may be required. This role requires the ability to communicate effectively with providers, staff, and external partners, and to maintain confidentiality of sensitive credentialing information.