Provider Data Maintenance Specialist

Company Overview

Associated Care Ventures, Inc. (ACV) is the Birmingham-based parent company of Simpra Advantage, Inc., an Alabama domiciled insurance company operating an Institutional Special Needs Plan, a Dual Eligible Special Needs Plan, and an Institutional Equivalent Special Needs Plan. ACV is the parent company of Alabama Select Network, LLC, which is operating an Integrated Care Network for the Alabama Medicaid Agency, to coordinate Medicare and Medicaid services state-wide for eligible individuals receiving long term services and supports, both living at home and in nursing facilities.

Position Summary

The Provider Data Maintenance Specialist is responsible for maintaining accurate and up-to-date provider information within organizational systems to support provider network operations, credentialing activities, claims processing, and member access to care. This role ensures the integrity of provider demographic, affiliation, and contract data for both participating and non-participating providers. The position works closely with internal departments, delegated entities, providers, and credentialing vendors to ensure provider records are maintained accurately and timely.

Major Duties and Responsibilities

Role/Responsibilities:

• Maintain and update provider records, including demographic information, practice locations, affiliations, contract assignments, APG assignments, and other provider data changes.
• Add new providers to network tracking tools and coordinate required onboarding activities.
• Collaborate with credentialing vendors to support initial credentialing and recredentialing processes.
• Assign and maintain appropriate contract affiliations for participating and non-participating providers.
• Process provider record updates, including affiliations, practice locations, contract assignments, APG assignments, and other provider data changes.
• Respond to provider inquiries regarding approval status, effective dates, credentialing requirements, and network participation changes.
• Maintain organized electronic records and documentation in accordance with departmental policies and procedures.
• Participate in data audits, testing activities, and quality reviews to ensure data accuracy and integrity.
• Identify and escalate provider data discrepancies, system issues, and record inconsistencies to leadership as appropriate.
• Support provider directory accuracy and other regulatory or operational reporting requirements.
• Collaborate with internal teams to ensure timely and accurate provider data maintenance.
• Perform other duties and special projects as assigned.

Education, Skills, & Knowledge - Qualifications & Experience

Education and Experience requirements

• 2 years of experience in healthcare, provider relations, network operations, or credentialing
• Knowledge of provider credentialing, provider data management, or healthcare operations
• Previous provider data loading and maintenance experience
• Experience with data uploads, file validation, and quality review processes
• Ability to follow up consistently and manage timelines effectively
• Experience with a health plan, managed care organization, or Medicare Advantage
• Experience working with Credentialing Verification Organization (CVO) or provider data systems preferred

Specialized Skills/Knowledge

• Proficiency in Microsoft Excel and general MS Office application
• Ability to adapt to a fast paced, continually changing business and work environment while managing multiple priorities.
• Requires strong attention to detail and commitment to data accuracy
• Excellent communication skills (written and verbal) with providers and internal stakeholders
• Strong organizational skills with the ability to manage multiple providers and tasks simultaneously

Compensation

• Salary will be commensurate with length and complexity of experience in Provider Data Maintenance roles. Salaried position provides full benefits package, including but not limited to BCBSAL health insurance, 401k, paid vacation, and personal days.

Job Type: Full-time

Pay: $50,000.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Paid time off
• Vision insurance

Experience:

• SQL: 1 year (Preferred)

Work Location: Remote

Salary : $50,000