Job Title: Remote Provider Data Validation Specialist
Pay Rate: $24.37/hour
Location: Remote – Must reside in one of the following states and work Eastern Standard Time (EST) hours:
AZ, FL, GA, ID, IA, KY, MI, NE, NM, NY (outside greater-NYC), OH, TX, UT, WA (outside greater-Seattle), WI
Work Hours: Monday–Friday, 8:00 AM–5:00 PM EST
Position Summary:
We are seeking a detail-oriented Provider Data Validation Specialist to join our remote team. In this role, you will review and validate provider applications against internal databases, audit provider information, and initiate updates as needed to ensure data accuracy for claims adjudication.
Key Responsibilities:
Review incoming emails and provider applications against primary databases.
Identify discrepancies and submit update requests to downstream data entry teams.
Communicate with providers primarily through email; excellent written communication skills are essential.
Accurately enter and maintain provider demographic and contract affiliation data.
Audit provider records for quality and financial accuracy, providing documented feedback.
Assist with system/health plan integration efforts and internal testing.
Support training for current staff and new hires as needed.
Required Qualifications:
Provider Data Validation and Auditing Experience (Must Have)
High School Diploma or equivalent (GED)
0–2+ years of experience in managed care
Excellent attention to detail and data accuracy
Proficiency with Microsoft Office Suite (Outlook, Word, Excel, Access)
Strong organizational and time management skills
Ability to learn internal systems (e.g., QNXT)
Excellent written and verbal communication skills
Ability to work independently and meet deadlines
Comfortable handling confidential information and complying with HIPAA regulations
Technical Requirements:
Reliable high-speed internet connection
Laptop, keyboard, mouse, headset (provided)
Dual monitors and docking station required (must be candidate-provided)
Additional Information: