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Provider Data Management Specialist at Magellan Health

Posted in Information Technology 30+ days ago.

This job brought to you by eQuest

Type: Full-Time
Location: Cambridge, Massachusetts

Job Description:

This position has the ability to work remote / telecommute for the right individual.

Duties to include:

* Perform review, validation and accurate record set-up and data entry
* High familiarity with Excel spreadsheets required - bonus if familiar with QNXT system, but not required.
* Ensure providers are appropriately and accurately data entered into the QNXT system
* High level of data entry accuracy required - understanding of health insurance plans, provider information is a plus
* Understanding of NPI numbers, Tax ID numbers, billing structures for providers a plus
* Ability to validate provider data against multiple sources, QA data elements and correct errors
* Understanding of credentialing processes for providers helpful
* Provider data management experience or platform configuration experience a plus. Any experience entering and verifying provider data.
* Processing data / keying data into the system for our delegated provider network.
* Ability to work independently, and also with a team, giving attention to details, but process work quickly and efficiently necessary.

Responsible for timely and accurate data entry and maintenance of provider records or credentialing and contract information in multiple databases.

Researches and resolves data questions and complaints, and ensures that information in all databases is accurate and properly configured to support operations. Responsible for analyzing system impact, process analysis and testing automated solutions when business problems require automated information systems solutions. Responsible for monitoring special projects, reporting progress and coordinating efforts across teams. Must help train lower level peers.

  • Develops and maintains a deep understanding of the IT platform systems, and all of the areas connected with the business.

  • Works closely with management to handle more comprehensive and analytical organizational requests as well as determine the departmental processes and priorities. 

  • Performs review, correspondence and timely, accurate record set-up and data entry. Supports internal auditing process to ensure data accuracy and integrity. 

  • Responds to requests to update or change information and ensures that all changes are made within operational guidelines and accurately support all other system related functions. 

  • Configures systems, as necessary, to support departmental needs. 

  • Runs requests and QA analysis against system. Assists in testing in source system and documenting test results. Assists in testing data for new software releases. Develops and documents complex workflows and process analysis. 

  • Researches and responds to internal stakeholders regarding complex inquiries. Develops solutions and communicates outcomes by telephone and in writing.

  • Participate in creating and running macros/scripts/processes in order to auto load data into the system.

  • Works on identifying and resolving data discrepancies between systems.

  • Performs analysis of complex data structures as they relate to reporting and operations.

  • Supports the implementation of new business by ensuring data is accurately loaded in all applicable systems. 

  • Records daily activities using electronic and manual systems as directed

General Job Information



Provider Data Management Specialist



Job Family

Info Technology Group


United States of America

FLSA Status

United States of America (Non-Exempt)

Recruiting Start Date


Date Requisition Created


Work Experience

Customer Service


GED (Required), High School (Required)

License and Certifications - Required

License and Certifications - Preferred

Other Job Requirements


Managed care or other healthcare network development experience preferred.- 2 or more years experience in customer service, data management, communications, or credentialing verifications required. - 2 or more years experience in a behavioral health or related industry.Ability to type 45-50+ words per minute. Other standard office equipment including telephone, copy machines, personal computer software and mainframe/LAN data systems. Must possess a high level of technical aptitude and be able to organize and manage information in multiple system environments; manage multiple priorities, pay close attention to detail as well as be proficient in word processing and spreadsheet applications. Proven customer service skills and the ability to successfully analyze and procure solutions to problems in a fast paced production based environment.

Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, comply and attest to the security responsibilities and security controls unique to their position.