Position Purpose: Perform provider data management related activities based on plan and contract specifications and standard business rules – includes data analysis and entry, review of data via internet sites and other systems, usage of multiple systems and applications to validate data is complete and accurate, and investigation and resolution of data issues.
Education/Experience: Bachelor’s degree in a related field, or Associate’s degree in related field or equivalent experience and 2+ years of provider data management, credentialing or healthcare operations (i.e. claims processing, billing, provider relations or contracting) experience, preferably in a managed care, insurance, or medical office environment. Experience performing data analysis in Excel or similar tools strongly preferred.
• Set up and perform facility (hospitals and clinics) enrollment in the provider data management system
• Enroll providers and practitioners in the provider data management system
• Update facilities, providers, and practitioners with claims payment information
• Research, review and make updates within the provider data management system per provider requests
• Perform quality service checks on systemic data, inclusive of claims processing and provider directory information
• Perform research and resolve problems as necessary
• Train and mentor Provider Data Management Analyst I
EEO:
“Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of – Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans.”
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Story Behind the Need
- What is the purpose of this team?
- What is driving this need? (ex. Backfill for FTE or CW, new project, business growth)
- Describe the surrounding team (team culture, work environment, etc.) & key projects.
- Do you have any additional upcoming hiring needs, or is this request part of a larger hiring initiative?
Provider Data Management is responsible for ensuring provider information is accurate, complete, and loaded timely across all health plan systems. The team supports provider enrollment, demographics, contract affiliations, terminations, directory accuracy, compliance requirements, and provider data maintenance activities that directly impact claims processing, provider network management, and member access to care.
This request is being driven by a combination of workload demands, business growth, VSP and resource capacity needs.
The Provider Data Management team operates in a collaborative, fast-paced environment focused on accuracy, quality, and customer service. Team members work closely with Contracting, Credentialing, Configuration, Network Management, Compliance, and other operational business partners to ensure provider records are maintained correctly and efficiently. The team values cross-training, continuous learning, process improvement, teamwork, and accountability.
Key responsibilities and projects include:
- Provider enrollment and maintenance
- Provider roster processing
- Data quality and validation reviews
- Provider directory accuracy
- Network adequacy support
- WellCare and Medicare provider data initiatives
- Large-scale provider updates and implementations
- Regulatory and compliance-related provider data activities
- Process improvement and automation opportunities
Currently, this request supports current operational and staffing needs within Provider Data Management. Additional hiring needs may be evaluated based on workload volume, future business initiatives, staff transitions, and project demands. This position will also help support operational stability and provide flexibility for upcoming growth opportunities and business priorities.
Typical Day in the Role
- Walk me through the day-to-day responsibilities and a description of the project (Outside of the Workday JD).
- What are performance expectations/metrics?
- What makes this role unique?
The Provider Data Management (PDM) team is responsible for maintaining accurate provider data across multiple systems to support provider participation, claims payment, directory accuracy, compliance, and member access to care. Daily responsibilities typically include:
- Reviewing and processing provider enrollment, demographic, affiliation, and termination requests.
- Researching and resolving provider data discrepancies.
- Working provider rosters and large-scale provider update projects.
- Validating provider information before loading or updating records.
- Collaborating with Contracting, Credentialing, Configuration, Network Management, and Health Plan partners.
- Investigating and resolving inventory items, escalations, and aging work queues.
- Performing quality reviews and post-load validation to ensure data accuracy.
- Supporting provider directory accuracy and network adequacy initiatives.
- Participating in project work related to provider data implementations, regulatory requirements, system enhancements, and process improvements.
The current project work is focused on maintaining accurate provider data while supporting ongoing business initiatives, roster processing, provider maintenance activities, directory reviews, and health plan operational priorities.
Performance is generally measured by:
- Productivity and timely completion of assigned inventory.
- Adherence to service level agreements (SLAs) and turnaround times.
- Accuracy and quality of provider data updates.
- Quality audit results and error rates.
- Ability to manage aging inventory and meet deadlines.
- Compliance with established processes and documentation requirements.
- Collaboration and responsiveness with business partners and providers.
- Participation in cross-training and continuous improvement efforts.
This role offers a unique opportunity to work at the center of provider operations. Provider data serves as the foundation for many critical business functions including provider directories, claims processing, network adequacy, credentialing, member attribution, and regulatory compliance. Errors or delays in provider data can directly impact providers, members, and health plan operations.
What makes this role especially rewarding is:
- High visibility across multiple departments.
- Exposure to complex provider operations and healthcare systems.
- Opportunities to solve problems and improve processes.
- Direct impact on provider experience and member access to care.
- Variety of work, including operational processing, research, project support, and collaboration with business stakeholders.
- Strong opportunities for learning and career growth within provider operations and healthcare administration.
This position is ideal for someone who enjoys analytical work, problem-solving, collaboration, and working in a fast-paced environment where accuracy and attention to detail are critical.
Candidate Requirements: Seeking a strong, analytical Business Analyst II who can quickly learn complex processes, independently analyze data, identify root causes and process gaps, and drive issues through resolution. Looking for someone who is highly detail-oriented, solutions-focused, comfortable working with large datasets and reporting tools, and able to effectively communicate findings and recommendations to both business and technical stakeholders. Healthcare/provider data experience is a plus.
Education/Certification
Required: Bachelor’s degree in a related field, or Associate’s degree in related field or equivalent experience and 2+ years of provider data management, credentialing or healthcare operations (i.e. claims processing, billing, provider relations or contracting) experience, preferably in a managed care, insurance, or medical office environment. Experience performing data analysis in Excel or similar tools strongly preferred.
Preferred:
Licensure
Required:
Preferred:
Years of experience required: Bachelor’s degree in a related field, or associate’s degree in related field or equivalent experience and 2+ years of provider data management, credentialing or healthcare operations (i.e. claims processing, billing, provider relations or contracting) experience, preferably in managed care, insurance, or medical office environment. Experience performing data analysis in Excel or similar tools is highly preferred.
Disqualifiers:
Additional qualities to look for:
- Top 3 must-have hard skills stack-ranked by importance
1
Xcel, systems savvy etc.
2
quickly learn complex processes
3
identify root causes and process gaps, and drive issues through resolution
Candidate Review & Selection
- Shortlisting process
- Candidate review & selection
- Interview information
- Onboard process and expectations
Projected Manager Candidate Review Date:
1-2 days post shortlisting
Type of Interviews:
Teams, phone, etc.
Required Testing or Assessment (by Vendor):
Typing test, basic computers skills test, etc.
Next Steps
- Do you have any upcoming PTO?
No
- Colleagues to cc/delegate
Kesa Jackson, Pravi Gunaratne
