Network Data Specialist
FLORIDA DOCTORS GROUP CORP
Job Description
Job Description
Benefits:
- Opportunity for advancement
- Paid time off
- Training & development
- Vision insurance
- Bonus based on performance
- Company parties
- Dental insurance
- Coordinate provider and facility credentialing with multiple commercial and government health plans.
- Complete and submit provider and facility credentialing and contracting applications.
- Perform primary source verification of provider credentials, including:
- State Licenses
- DEA Registrations
- Board Certifications
- Malpractice Insurance
- Professional Liability History
- Sanction Monitoring
- Education and Training Verification
- Maintain accurate provider demographic, credentialing, and contracting information across internal databases and health plan portals.
- Monitor license, certification, DEA, malpractice, and other credential expiration dates to ensure continuous compliance.
- Update provider records and practice information with health plans and regulatory agencies.
- Audit provider directories to ensure information remains current and accurate.
- Research and resolve provider data discrepancies with insurance companies and internal departments.
- Collaborate with Provider Relations, Contracting, Quality, Billing, and Operations teams to resolve provider issues.
- Assist with provider onboarding and network maintenance initiatives.
- Maintain accurate documentation and tracking throughout the credentialing lifecycle.
- Participate in special projects and other duties as assigned.
- Strong attention to detail and exceptional organizational skills.
- Ability to prioritize multiple projects while meeting deadlines.
- Strong analytical and problem-solving abilities.
- Excellent verbal and written communication skills.
- Ability to work independently while collaborating effectively with multiple departments.
- Professionalism when communicating with physicians, office managers, insurance representatives, and leadership.
- Proficiency with Microsoft Office (Excel, Outlook, Word, Teams).
- Experience working with online health plan portals and provider databases is preferred.
- Knowledge of CAQH, NPPES, PECOS, and provider enrollment systems is a plus.
- Understanding of healthcare credentialing, provider enrollment, contracting, or provider data management is preferred.
- 1-3 years of experience in healthcare administration, provider credentialing, provider enrollment, medical office administration, health plan operations, or provider data management.
- Experience working with Medicare Advantage, Medicaid, Commercial, or Marketplace health plans is highly desirable.
- Associate's or Bachelor's degree preferred, but equivalent experience will also be considered.
Vacancy posted 22 days ago
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