Provider Data Representative
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Job Description
Provider data representative maintaining accurate healthcare records for GDIT’s World Trade Center Health Program. Supporting credentialing, claims payment, directories, audits, and operational reporting.
Responsibilities:
- Maintain accurate provider demographic, participation, credentialing, enrollment, roster, and directory information across systems supporting the World Trade Center Health Program
- Process provider roster submissions, updates, additions, terminations, and changes within service-level agreements
- Validate and update NPIs, TINs, specialties, practice locations, EFT details, affiliations, and licenses
- Reconcile provider rosters against credentialing, claims, enrollment, and directory systems
- Identify and coordinate resolution of discrepancies affecting participation, claims payment, reimbursement, or directory accuracy
- Support credentialing and recredentialing, onboarding, enrollment, and participation activation
- Audit provider records for completeness, accuracy, and compliance
- Monitor directory accuracy, quality scores, and claims-impacting error rates
- Support data standards, quality assurance programs, process improvements, automation, workflows, templates, and operational tools
- Produce provider data quality reports, discrepancy logs, dashboards, and audit results
- Track productivity, turnaround times, accuracy metrics, and issue remediation
- Communicate data requirements and discrepancies to credentialing, enrollment, and provider relations teams
- Collaborate with Provider Relations, Credentialing, Provider Data, Claims Operations, and Contracting
- Provide insights to leadership and support root-cause analysis and remediation
Requirements:
- 3+ years of experience in provider data, credentialing, enrollment, or health plan operations
- Strong analytical skills
- Proficiency in Microsoft Excel
- Exceptional attention to detail and accuracy
- Experience supporting federal or government-sponsored healthcare programs
- Knowledge of provider directory regulatory requirements and healthcare data standards
- Experience with provider portals, enrollment systems, or enterprise provider data platforms
- Bachelor's degree preferred
- No US citizenship required
- MBI (T2) public trust/other requirement
- Less than 10% travel
Benefits:
- Medical plan options, including plans with Health Savings Accounts
- Dental plan options
- Vision plan
- 401(k) plan with pre- and post-tax contributions and company match
- Full flex work weeks where possible
- Vacation, sick, personal, holiday, parental, military, bereavement, and jury duty leave
- Typically 15 days of paid leave per calendar year for new employees
- 10 paid holidays per year
- Up to 160 hours of paid family leave in a rolling 12-month period for eligible employees
- Short- and long-term disability benefits
- Life insurance
- Accidental death and dismemberment insurance
- Personal accident insurance
- Critical illness insurance
- Business travel and accident insurance
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