Provider Data Specialist

Role Description

Paradigm is seeking a full-time, fully remote Provider Data Specialist. The schedule for this position is Monday - Friday, 8 AM to 5 PM, 9 AM to 6 PM, or 10 AM to 7 PM.

The Provider Data Specialist is responsible for collecting, verifying, maintaining, and managing provider credentialing and participation data across multiple systems. This role supports credentialing operations by ensuring accurate, complete, and compliant provider files in accordance with company policies, accreditation standards, and state and federal regulations. The Provider Data Specialist works collaboratively with internal teams and external providers, maintains strict confidentiality of sensitive information, and contributes to reporting and process support that enables efficient network and credentialing operations.

Duties and Responsibilities

• Requests, receives, processes participating provider information across multiple databases.
• Processes request, investigation, verification, tracking and follow up of primary responses from various sources.
• Identifies, investigates, reports, tracks, and follows-up on any potentially adverse information received from credentialing sources.
• Obtains and maintains appropriate knowledge of company policy and procedures, accreditation standards, state and federal regulations, guidelines, procedures and laws required in credentialing process.
• Populates, updates, and maintains database software and filing systems.
• Assists with Requests for Proposals or any requested reports as necessary and in collaboration with supervisor or other Credentialing Services staff.
• Maintains practitioner files annually.
• Ensures provider credentialing documents are present for affiliated community practitioners.
• Participates in professional organizations and/or other organizations addressing Provider Data.
• Maintains strict confidentiality of all records, data and occurrences as condition of initial and/or continued employment.
• Maintain reliable and predictable attendance during scheduled work hours.

Qualifications

• Bachelor's degree in health care or technical field preferred, call center experience a plus.
• Exceptional communication and telephone skills are required, as well as a great deal of patience and understanding.
• Experience working with physicians and/or senior executives preferred.
• Possess a high level of self-confidence and persistence; maintain an assertive approach in dealing with providers.
• Must possess excellent organizational skills and the ability to multi-task effectively.
• Demonstrate the ability to prioritize heavy workload and work independently with minimal supervision.
• Proficient computer and internet skills; familiarity with Microsoft Office software required.
• Knowledge of medical terminology preferred.
• Will develop in-depth knowledge of department and company internal workflows including but not limited to individual state’s procedures and negotiating protocols.
• Bilingual a plus.

Benefits

• Health and wellness: PPO, HDHP, and HMO health insurance options with Cigna and Kaiser (CA employees only).
• Financial incentives: competitive salaries, 401(k) matching contributions, employer-paid life and disability insurance, flexible spending and commuter accounts, and employer-matched HSA contributions.
• Vacation: paid time off and personal holiday programs for work-life balance.
• Volunteer time: one paid day per calendar year for community engagement.
• Learning and development: support for continual learning through the Learning Excellence at Paradigm (LEAP) program.