When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives.
The Provider Data Management Specialist is responsible for the day-to-day administration, maintenance, support, and optimization of database systems that support provider credentialing, privileging, and enrollment functions. This role serves as the primary functional and technical resource for credentialing-related databases, ensuring data integrity, system effectiveness, reporting accuracy, and compliance with organizational and regulatory requirements. The Provider Data Management Specialist partners with internal stakeholders, vendors, and information systems teams to support provider data management and operational processes.
Job Description:
Essential Duties & Responsibilities including but not limited to:
Database Administration & System Support:
Administer and maintain databases utilized to support credentialing, privileging, and provider enrollment operations.
Serve as the functional and technical subject matter expert for credentialing database applications.
Monitor system performance and data quality to ensure accurate, timely, and reliable information.
Coordinate with software vendors and information technology teams on system enhancements, upgrades, troubleshooting, and issue resolution.
Ensure database integrity, security, confidentiality, and compliance with applicable organizational policies and standards.
Develop, maintain, and update system configuration elements, forms, templates, rosters, reports, and tracking mechanisms.
CAQH data support:
Provider enrollment platform management
Data governance and audits
NCQA/CMS/accreditation reporting support
Provider directory data integrity
Cross-functional support for Credentialing, Enrollment, and Facility Credentialing operations Reporting and Data Management
Generate routine and ad hoc reports to support operational, regulatory, and leadership needs.
Analyze and validate provider and credentialing data to support business decision-making and compliance activities.
Develop reports and data extracts to support credentialing, privileging, enrollment, and operational initiatives.
Maintain accurate provider data and support data governance efforts.
Training and Stakeholder Support:
Provide training and ongoing support to database users.
Serve as a liaison among Medical Staff Services personnel, operational leaders, information systems teams, and external vendors.
Support system implementations, upgrades, testing, and process improvement initiatives.
Promote excellent customer service and collaborative relationships with internal and external stakeholders.
Quality, Compliance, and Organizational Support :
Maintain compliance with all organizational confidentiality, privacy, and security requirements.
Participate in quality improvement initiatives and departmental projects.
Complete required education and training programs.
Perform additional duties and special projects as assigned to support operational needs.
Organizational Requirements :
Maintain strict adherence to all BILH and BILHPN Policies. Maintain courteous and effective interactions with colleagues and providers, and stakeholders. Demonstrate an understanding of the job description, performance expectations, and competency assessment. Demonstrate a commitment toward meeting and exceeding the needs of our customers and consistently adhere to customer service standards. Participate in departmental and/or interdepartmental quality improvement activities. Participate in and successfully completes Mandatory Education. Perform all other duties as needed or directed to meet the needs of the department.
Minimum Qualifications:
Education: · High School Diploma or GED required. Associate degree in Computer Science, Information Technology, Health Information Management, Business Administration, or a closely related field preferred.
Experience:
Knowledge of MD-Staff credentialing software and associated…