This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Senior Specialist, Provider Network Administration based in the United States.
This remote opportunity is ideal for an experienced healthcare operations professional who excels at data accuracy, reporting, and provider network administration. In this role, you will help maintain reliable provider information across claims and provider databases, supporting efficient network operations and high-quality service delivery. You will prepare and analyze reports, validate provider records, and ensure compliance with internal standards and regulatory requirements. Working closely with cross-functional teams, you will help resolve configuration issues, improve data quality, and support provider network projects. You will also contribute to team development by sharing expertise and training colleagues. This position offers the opportunity to apply your healthcare knowledge and analytical skills in a detail-oriented, collaborative environment.
Accountabilities
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Generate, prepare, validate, and distribute provider-related data and reports to support network administration, operational efficiency, and continuous quality improvement.
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Maintain accurate provider information across applicable systems, including demographic data, affiliations, fee schedule attachments, and other critical records.
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Prepare and maintain provider directories and supporting reports, including GeoAccess availability reports, online provider directories, Medicare provider directories, and Federally Qualified Health Center (FQHC) and Rural Health Clinic (RHC) reports.
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Produce additional reports and data extracts related to claims, network management, emergency room activity, network access fees, and mailing labels.
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Review and analyze provider data to verify completeness, accuracy, and alignment with business and system requirements.
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Audit provider records for data quality and financial accuracy, documenting findings and providing feedback to support corrective action.
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Develop and maintain documentation, procedures, and guidelines for assigned areas of responsibility.
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Collaborate with relevant teams to troubleshoot and resolve configuration issues affecting provider network administration.
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Support provider network administration projects and contribute to the effective implementation of operational initiatives.
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Provide guidance, training, and ongoing support to new and existing team members.
Requirements
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At least four years of healthcare experience in claims, provider services, provider network operations, hospital or physician billing, or an equivalent combination of relevant education and experience.
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Hands-on claims processing experience, including coordination of benefits, subrogation, and/or eligibility criteria.
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Familiarity with medical terminology, Current Procedural Terminology (CPT), and International Classification of Diseases (ICD-9/ICD-10) codes.
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Strong attention to detail and the ability to enter, validate, review, and process data accurately.
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Proficiency in data entry and processing, with the ability to maintain high standards of data integrity and quality.
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Strong customer service skills and the ability to work effectively with internal stakeholders.
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Excellent organizational skills, including the ability to manage multiple priorities, meet deadlines, and maintain accuracy under competing demands.
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Effective written and verbal communication skills, with the ability to document procedures and communicate findings clearly.
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Proficiency with Microsoft Office applications, particularly intermediate-level Microsoft Excel skills, and the ability to use relevant business software.
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Preferred: Experience with query languages.
Benefits
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Salary: Annual compensation ranging from $40,851.44 to $88,511.46, depending on geographic location, work experience, education, and skill level.
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Work arrangement: Remote position based in the United States.
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Schedule: Full-time employment.
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Compensation and benefits: A competitive compensation and benefits package is offered. Specific benefits and individual plan details were not provided in the job description.