POSITION SUMMARY
The Network Data Specialist II is responsible for advanced management, analysis, configuration, and validation of provider data across enterprise provider, claims, and network management systems. This role ensures the accuracy, integrity, and operational readiness of complex provider data configurations that support claims adjudication, network operations, regulatory compliance, and business reporting.
The Network Data Specialist II serves as a subject matter resource for provider data processes, independently manages complex data activities, identifies opportunities for process improvements, and collaborates with Provider Relations, Credentialing, Claims, Network Operations, and IT teams to resolve data issues and enhance system performance.
ESSENTIAL DUTIES & RESPONSIBILITIES
· Load contracted (participating) providers into provider and claims systems in accordance with executed provider agreements and configuration requirements.
· Load and maintain non-participating provider records to ensure accurate claims processing and pricing.
· Maintain accurate, complete, and up-to-date provider data across all claims and provider databases.
Provider Data Management
Ensure integrity of critical provider information including:
· Provider demographics
· Tax ID and billing information
· Specialty and taxonomy codes
· Network participation status
· Contract effective dates and terms
· Validate provider data accuracy prior to system loading and ongoing updates.
· Apply advanced business rules and system requirements to ensure accurate provider setup across downstream applications.
· Identify data trends, recurring issues, and opportunities to improve provider data accuracy and operational efficiency.
System Maintenance & Data Synchronization
· Perform advanced provider data synchronization across multiple claims, provider, and configuration platforms.
· Analyze discrepancies between systems and source documentation and coordinate corrective actions.
· Ensure consistency of provider information across enterprise platforms.
· Identify and resolve data discrepancies between systems and source documentation.
· Support updates to provider files based on contracting, credentialing, or network changes.
Provider Relations & Credentialing Collaboration
· Partner with Provider Relations, Credentialing, Claims, and Network Operations teams to resolve complex provider data issues..
· Work closely with Credentialing teams to ensure only appropriately credentialed providers are loaded and active in systems.
· Validate credentialing status and en