Job Description

Provider Data Management Coordinator

eternalHealth – The Next Generation of Medicare Advantage

Healthcare is confusing, but it doesn’t need to be. A consumer-centric health plan based in Boston, MA, we are a tech-focused start up that is committed to creating long-lasting partnerships with our members, our providers, and you!

About this role: The Provider Data Management Coordinator is responsible for maintaining the accuracy and compliance of provider data in accordance with internal, regulatory, and state requirements. This position ensures that provider databases are kept up to date, processes all necessary updates, produces essential reports, and supports functions related to network operations, quality assurance, and claims services.

• Key responsibilities include maintaining provider data accuracy and compliance.
• Updating provider databases.
• Generating essential reports.
• Supporting network operations, quality assurance, and claims services.

Key Responsibilities

• Database Maintenance: Add, update, and terminate provider records including demographic, credentialing, and contract information, ensuring data is processed both timely and accurately.
• Provider Outreach: Collaborate with Provider Representatives to conduct outreach to contracted providers as needed for roster updates
• Reporting: Generate regular status and compliance reports on a daily and weekly basis for internal and external stakeholders.
• Compliance Monitoring: Monitor provider data to ensure ongoing compliance with state regulatory requirements and internal company policies.
• Audit Support: Reconcile provider data, respond to audit requests, and verify that claims provider setup is accurate and complete.
• Administrative Duties: Maintain files, track data change requests, and provide statistical and analytical support as required.
• Data Accuracy: Ensure provider data remains accurate, current, and compliant with all requirements.
• Report Generation: Process updates and generate necessary reports related to provider database maintenance.
• Operational Support: Assist with network operations, quality assurance, and claims services.
• Primary Contact: Serve as the main point of contact for provider demographic changes, terminations, additions, reconciliations, and audit activities.
• Collaboration: Work closely with internal teams and external providers to ensure data submissions are timely and accurate.
• Auditing: Perform regular audits to verify provider data is accurate and complete.
• Policy Development: Assist in developing and implementing policies and procedures for effective data management.
• Training and Support: Provide training and guidance to internal teams on provider data management processes.
• Additional duties as assigned.

Qualifications and Skills

• High school diploma or equivalent required; Associate’s degree in a related field is often preferred.
• Experience in provider data management, network administration, or within a managed care environment.
• Strong attention to detail and excellent organizational skills.
• Effective communication and interpersonal abilities.
• Proficiency in data management software and related tools.
• Capability to work independently and collaboratively within a team.
• Familiarity with regulatory and compliance requirements related to provider data management.

Working with eternalHealth : eternalHealth is an Equal Opportunity Employer which means that we are committed to upholding discrimination-free hiring practices. As a woman-led company, and one committed to diversity at all levels, we strive for an organization of inclusion and acceptance. We are changing healthcare for the better, starting with our own diverse and passionate teams. As an eternalHealth employee you will be empowered to contribute to our teams and strategy, regardless of previous healthcare experience. Our valued team members are encouraged and expected to offer new solutions and creative input, all while keeping in line with eternalHealth’s mission, values, and compliance standards.

Accommodation : Any eternalHealth applicant will be considered based entirely on their individual qualifications. Should you require reasonable accommodation during the application process (which may include a job-related assessment) please contact us separately at [email protected].

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