Provider Data Representative

🔥 13 hours ago

🇺🇸 United States – Remote

💵 $72.9k - $98.6k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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General Dynamics Information Technology

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1954

💼 Consulting

🏥 Healthcare

📦 Logistics

Consulting • Healthcare • Logistics

General Dynamics Information Technology is a company at the forefront of technological innovation, offering a wide range of services including consulting, digital modernization, and application services. The company is heavily involved in implementing solutions related to artificial intelligence, cloud computing, cybersecurity, high-performance computing, and quantum technologies. GDIT is committed to supporting government and defense sectors, providing mission-critical services such as logistics and supply chain management, intelligence, and homeland security. The company also focuses on diverse and inclusive hiring practices and actively promotes employee well-being. Through its digital accelerator solutions and pioneering use of emerging technologies, GDIT aims to propel agencies' missions forward and address complex technological challenges.

📋 Description

• Maintain accurate provider directory data • Resolve issues arising from directory discrepancies • Process provider demographic changes, additions, terminations, and updates within service-level expectations • Reduce backlog and improve turnaround time through efficient workflow management • Validate and maintain NPIs, TINs, specialties, practice locations, affiliations, licensure, and EFT data • Identify and reduce claims-impacting data errors and support audit readiness • Reconcile provider rosters against credentialing, enrollment, claims, and directory systems • Coordinate correction of participation and claims-payment discrepancies with cross-functional teams • Validate provider demographic data for onboarding, credentialing, and recredentialing • Resolve participation or enrollment inconsistencies • Identify data issues impacting claims adjudication, reimbursement, or provider participation • Partner with Claims Operations on discrepancy resolution and root-cause analysis • Generate dashboards, productivity logs, discrepancy reports, and data quality metrics • Track turnaround times, accuracy rates, and productivity and provide leadership insights • Communicate data requirements, corrections, and discrepancies to credentialing, enrollment, and provider relations teams • Maintain documentation supporting provider updates and operational workflows • Recommend workflow enhancements, automation opportunities, and system updates • Support implementation of new tools, templates, and operational processes

🎯 Requirements

• 3+ years of experience in provider data, credentialing, enrollment, or health plan operations • Strong analytical skills • Proficiency in Microsoft Excel • Exceptional attention to detail and accuracy • Bachelor’s degree preferred • Experience supporting federal or government-sponsored healthcare programs preferred • Knowledge of provider directory regulatory requirements and healthcare data standards preferred • Experience with provider portals, enrollment systems, or enterprise provider data platforms preferred • US Citizenship Required: No • Travel required: Less than 10%

🏖️ Benefits

• Full-flex work week • 401K with company match • Comprehensive health and wellness packages • Internal mobility team • Professional growth opportunities including paid education and certifications • Cutting-edge technology you can learn from • Paid vacation and holidays • Medical plan options, including some with Health Savings Accounts • Dental plan options • Vision plan • Paid sick and personal time • Paid parental, military, bereavement, and jury duty leave • Up to 160 hours of paid family leave in a rolling 12-month period for eligible employees • Short- and long-term disability benefits • Life insurance • Accidental death and dismemberment insurance • Personal accident insurance • Critical illness insurance • Business travel and accident insurance