Provider Data And Enrollment Specialist Ii

The primary role of the Provider Data Enrollment Specialists II is to ensure the data integrity of provider records entered and maintained in the credentialing and/or payment systems. This position may be responsible for all aspects of ensuring accurate and timely processing of provider setup to initiate credentialing, provider record updates and edits, processing provider terminations, and researching and resolving provider setup issues in the applicable systems. This position is also responsible for remediating capitation-related provider data issues and regulatory-related research and updates. This data maintenance will support network adequacy and growth, regulatory reporting, provider directories, as well as downstream systems and processes. BA preferred. Minimum of 3 years experience in healthcare insurance working with provider, network, or contract data; or a combination of education and experience, which would provide an equivalent background Understanding health claims processing is a plus