Overall Purpose:

The Provider Data Management Specialist is responsible for overseeing the accuracy, integrity, and maintenance of provider data within P3 internal systems. The Provider Data Management Specialist ensures data integrity across systems to support claims processing, provider directories, regulatory compliance, and operational efficiency. This role acts as a liaison between internal contracting, health plans, and credentialing to ensure successful maintenance of data through all stages of provider enrollment.

Essential Functions

• Supports contracting and credentialing with obtaining accurate provider data. Responsible for building positive relationships between the health plan, providers and practice managers.
• Manage processes for provider data integration and system enhancements, working with systems to develop reporting. This includes supporting the development and publication of provider directories for various internal stakeholders. Serve as the primary point of contact for provider data-related inquiries and issue resolution. Maintains, audits, and updates notice of change documentation for all providers.
• Identifying gaps in network composition and services to assist the department.
• Identifying operational short-falls, researching and remediating issues.
• Handles confidential and non-routine information.
• Delivers assigned projects on time and compliant to applicable state and federal regulations. Organizes and prioritizes large volumes of information.
• General administrative duties.

Knowledge, Skills, and Abilities

• Must have a high level of interpersonal skills to handle sensitive and confidential situations. Position continually requires demonstrated poise, tact and diplomacy.
• Must have excellent verbal and written skills.
• Must be able to interact and communicate with individuals at all levels of the organization and external parties.
• Must have knowledge of variety of computer software applications in word processing, spreadsheets, database and presentation software (Word, Excel, Access, PowerPoint)
• Work requires continual attention to detail in composing, typing and auditing large amounts of data. contracts.
• Must be able to work in a fast-paced environment with demonstrated ability to juggle multiple competing tasks and demands.
• Excellent organization and coordinating skills.

Experience

• Must have a minimum of five years of work experience in managed care and strong relationship building skills.

Education

• Associates Degree preferred or in process of completion or equivalent experience.