Provider Data Specialist
Verda Healthcare
Date: 11 hours ago
City: Huntington Beach, CA
Contract type: Full time
Description
Verda Health Plan of Texas has a contract with the Center of Medicaid and Medicare Services (CMS) and a state license with the Texas Department of Insurance for a Medicare Advantage Prescription Drug (MAPD) plan. We are committed to the idea that healthcare should be easily and equitably accessed by all. Our mission is to ensure that underserved communities have access to health and wellness services, and receive the support needed to live a healthy life that is free of worry and full of joy. We are looking for a Provider Data Specialist to join our growing company with many internal opportunities.
Are you ready to join a company that is changing the face of health care across the nation? Verda Healthcare health plan is looking for people like you who value excellence, integrity, care and innovation. As an employee, you’ll join a team dedicated to improving the lives of our Medicare members. Our vision incorporates value-based health care that works. We value diversity.
Align your career goals with Verda Healthcare, Inc. and we will support you all the way.
Position Overview
The Provider Data Specialist is responsible for maintaining the accuracy, integrity, and completeness of provider information within the organization’s data systems. This role ensures that healthcare provider records are up-to-date and compliant with regulatory standards and internal policies, supporting critical functions such as claims processing, provider directory accuracy, credentialing, and network management.
Working closely with provider relations, credentialing teams, and IT, the Provider Data Specialist reviews, inputs, and audits provider data from various sources including contracts, rosters, and other data systems. The ideal candidate is detail-oriented, analytical, and adept at navigating multiple data systems while meeting tight deadlines in a fast-paced environment.
This position reports to the Business Systems Manager.
Responsibilities
Minimum Qualifications
Job Type: Full-time
Benefits
Regularly sit/walk at a workstation in an office or cubicle setting. Must occasionally lift and/or move up to 25-50 pounds.
Verda Health Plan of Texas has a contract with the Center of Medicaid and Medicare Services (CMS) and a state license with the Texas Department of Insurance for a Medicare Advantage Prescription Drug (MAPD) plan. We are committed to the idea that healthcare should be easily and equitably accessed by all. Our mission is to ensure that underserved communities have access to health and wellness services, and receive the support needed to live a healthy life that is free of worry and full of joy. We are looking for a Provider Data Specialist to join our growing company with many internal opportunities.
Are you ready to join a company that is changing the face of health care across the nation? Verda Healthcare health plan is looking for people like you who value excellence, integrity, care and innovation. As an employee, you’ll join a team dedicated to improving the lives of our Medicare members. Our vision incorporates value-based health care that works. We value diversity.
Align your career goals with Verda Healthcare, Inc. and we will support you all the way.
Position Overview
The Provider Data Specialist is responsible for maintaining the accuracy, integrity, and completeness of provider information within the organization’s data systems. This role ensures that healthcare provider records are up-to-date and compliant with regulatory standards and internal policies, supporting critical functions such as claims processing, provider directory accuracy, credentialing, and network management.
Working closely with provider relations, credentialing teams, and IT, the Provider Data Specialist reviews, inputs, and audits provider data from various sources including contracts, rosters, and other data systems. The ideal candidate is detail-oriented, analytical, and adept at navigating multiple data systems while meeting tight deadlines in a fast-paced environment.
This position reports to the Business Systems Manager.
Responsibilities
- Maintain up-to-date provider records across multiple databases and business systems
- Communicate with internal and external teams to create a seamless flow of data throughout claims, enrollment and other internal systems.
- Understanding industry standards and compliance regulations to clean, filter and reconcile data sent from external sources and provide clean information to internal teams and customers.
- Reporting functions to internal and external teams.
Minimum Qualifications
- Bachelor’s Degree in business, computer science, information technology, or equivalent business experience.
- Prior experience at a health plan, provider group or provider’s office required.
- Knowledge of MS Office Suite, including Excel and Word.
- Collaborative approach with vendors and internal team members.
- Strong analytical skills.
- Effective verbal and written communication.
Job Type: Full-time
Benefits
- 401(k)
- Paid time off (vacation, holiday, sick leave)
- Health insurance
- Dental Insurance
- Vision insurance
- Life insurance
- Full-time onsite (100% in-office)
- Hours of operation: 9am – 6pm
- Standard business hours Monday to Friday/weekends as needed
- Occasional travel may be required for meetings and training sessions.
- Reliably commute or planning to relocate before starting work (Required)
Regularly sit/walk at a workstation in an office or cubicle setting. Must occasionally lift and/or move up to 25-50 pounds.
- Other duties may be assigned in support of departmental goals.
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