Specialist, Provider Network Administration - Remote

Our client operates within the healthcare industry, focusing on provider network management to support effective healthcare delivery. They address the challenge of maintaining accurate and up-to-date provider information critical to claims processing and provider network operations. The organization ensures provider data remains aligned with business and system requirements while supporting operational efficiency and regulatory compliance.

About the role

The Specialist, Provider Network Administration supports the administration and maintenance of the provider network by validating and updating essential provider information accurately and efficiently. This role ensures data integrity across claims and provider databases while supporting provider contract management and network operations. The position contributes to improved provider data quality and reliability, which are essential to operational efficiency, claims accuracy, and customer service.

Responsibilities

• Receive and update provider-related information from external sources within the appropriate systems.
• Review and analyze provider data to confirm accuracy, completeness, and consistency.
• Maintain departmental quality standards for provider demographics and fee schedules.
• Accurately enter and maintain information within health plan systems.
• Audit provider records for quality and financial accuracy and provide documented feedback.
• Assist in identifying and resolving provider configuration issues in collaboration with relevant teams.
• Support provider network administration projects and initiatives.

Requirements

• Minimum of 3 years of healthcare experience, including claims, provider services, provider network operations, hospital billing, physician billing, or equivalent education and experience.
• Experience with claims processing, including coordination of benefits, subrogation, or eligibility requirements.
• Strong attention to detail with accurate data entry and information review.
• Proficient data entry and processing skills.
• Strong customer service skills.
• Ability to manage multiple priorities while consistently meeting deadlines.
• Effective verbal and written communication skills.
• Proficiency with Microsoft Office Suite and applicable healthcare or business software programs.

Preferred Qualifications

• Knowledge of medical terminology and coding systems, including CPT, ICD-9, and ICD-10.
• Intermediate proficiency with Microsoft Excel.