Top 15 Provider network configuration specialist Jobs in Doral Fl

Provider Network Configuration Specialist
Solis Health Plans —Doral, FL
- $25 - $27 an hour
- Full-time
- English
- Mid-level
- Office
- Health savings account
- Dental insurance
Quick Apply
11d
Network Specialist 1, Full-Time, Nights, Tuesday - Thursday 8:30pm-7:00am and Friday 10:30pm-9:00am
Jackson Health —Miami, FL
- Full-time
- Mid-level
- Windows
- High school diploma or GED
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IT Support Specialist
OneSpaWorld —Coral Gables, FL
- Weekends as needed
- Microsoft Word
- Microsoft Excel
- Mid-level
- Flexible schedule
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Benefits Specialist
ADP —Miami, FL
- Full-time
- Military
- Research
- Mid-level
- Health savings account
- Health insurance
8d
Healthcare Configuration and Data Integrity Manager
Provider Network Solutions LLC —Miami, FL
- $60,000 - $70,000 a year
- Full-time
- Microsoft Excel
- Microsoft Access
- Microsoft Outlook
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IT Specialist
MES Life Safety —Hallandale Beach, FL
- $60,000 - $80,000 a year
- 8 hour shift
- Mid-level
- Office
- Analysis skills
- Health savings account
- Paid holidays
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Onsite AV/IT Engineer
AVI-SPL —Miami, FL
- Full-time
- Clean driving record
- Construction site
- Mid-level
- Paid holidays
- Health insurance
RCM Contract Support Specialist
Integrated Home Care Acquisition —Miramar, FL
- Contract
- Remote
- Research
- Mid-level
- Home Health
- Paid training
- Wellness program
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Technical Support Specialist - Level II
Invizio —Miami, FL
- $55,000 - $75,000 a year
- Full-time
- Computer science
- Computer Science
- English
- Paid holidays
- Health insurance
Quick Apply
Microsoft Identity Entra ID Senior Consultant
Deloitte —Miami, FL
- $105,400 - $207,800 a year
- Full-time
- Computer Science
- Up to 50% travel
- 3 years
Specialist, Media Operations
AutoNation —Fort Lauderdale, FL
- Full-time
- Marketing
- Mid-level
- Finance
- Dental insurance
- Vision insurance
Quick Apply
RCM Contracts Manager
Integrated Home Care Acquisition —Miramar, FL
- Remote
- 5 years
- Mid-level
- Finance
- Paid training
- Wellness program
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Manager of End User Computing (EUC) & Client Architecture
AutoNation —Fort Lauderdale, FL
- Full-time
- Hybrid work
- Computer science
- Computer Science
- 5 years
- Dental insurance
- Vision insurance
Quick Apply
Verkada Architect
RSM Solutions Inc —United States
- $100 - $140 an hour
- Contract
- Remote
- Senior level
- 2 years
Quick Apply
11d

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Provider Network Configuration Specialist
Solis Health Plans —Doral, FL
Advanced proficiency with Microsoft Excel and data analysis tools. Experience working with provider databases, claims systems, or network configuration tools.
$25 - $27 an hour
Quick Apply
11d
Healthcare Configuration and Data Integrity Manager
Provider Network Solutions LLC —Miami, FL
The Configuration Manager will work with internal departments and external organizations to assure secure data exchanges, integrity, reliability, and…
$60,000 - $70,000 a year
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Provider Network Configuration Specialist

Solis Health Plans -
Doral, FL

Quick Apply

Job Details

Full-time
$25 - $27 an hour
11 days ago

Benefits

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

Qualifications

Teamwork
Spreadsheets
English
Databases
High school diploma or GED
Attention to detail
Cross-functional collaboration
Cross-functional communication
Data analysis software
Time management

Full Job Description

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 ensure alignment with network participation requirements prior to system activation.

· Support resolution of provider data issues identified by internal stakeholders or external providers.

· Provide recommendations regarding provider data processes, workflows, and configuration improvements.

Non-Participating Provider Configuration

· Manage complex non-participating provider configurations to support accurate claims routing, pricing logic, and out-of-network processing.

· Ensure non-participating provider data supports correct claims adjudication and out-of-network processing rules.

· Maintain accurate classification of provider participation status across systems.

Provider Rosters & Reporting

· Manage monthly provider roster updates, including additions, terminations, and changes.

· Reconcile provider rosters received from external sources against internal systems.

· Validate and distribute provider roster files to appropriate internal stakeholders.

· Support reporting needs related to provider network composition and data accuracy.

· Identify trends and recommend improvements related to provider data management.

Quality Assurance & Compliance

· Validate provider data against contractual requirements, network standards, and system specifications.

· Ensure compliance with internal policies and regulatory requirements related to provider data management.

· Maintain audit-ready documentation of provider data changes and updates.

Support internal and external audits by providing accurate documentation and detailed data analysis.

SUPERVISORY RESPONSIBILITY

· No.

QUALIFICATIONS & EDUCATION

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

Minimum Qualifications

· High School Diploma or GED required.

· Minimum of 3 years of experience in healthcare provider data management, claims systems, credentialing support, or managed care operations.

· Experience working with provider databases, claims systems, or network configuration tools.

· Equivalent combination of education and experience may be considered.

· Strong analytical skills with the ability to identify issues, analyze root causes, and implement solutions.

· advanced proficiency with Microsoft Excel and data analysis tools.

· Strong communication skills with the ability to collaborate across multiple business functions.

Preferred Qualifications

· Experience in managed care health plan or health insurance environment.

· Familiarity with provider credentialing and contracting processes.

· Understanding of provider taxonomy, NPI, and healthcare provider identifiers.

· Experience managing provider rosters or large-scale data files.

· Knowledge of claims adjudication systems and network configuration rules.

· Experience mentoring team members or serving as a subject matter expert.

Skills & Competencies

· Strong attention to detail and data accuracy

· Ability to manage large volumes of provider data efficiently

· Strong analytical and problem-solving skills

· Understanding of healthcare provider data structures and systems

· Ability to collaborate effectively with cross-functional teams

· Strong organizational and time management skills

· Ability to work independently in a production-driven environment

Additional Notes

The Network Data Specialist plays a critical role in ensuring the accuracy and integrity of provider data across the health plan’s systems. This position directly impacts claims accuracy, provider payment, for Recruitment purposes this position has been posted as Provider Network Configuration Specialist

Pay: $25.00 - $27.00 per hour

Benefits:

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

Language:

English (Required)

Ability to Commute:

Doral, FL 33192 (Required)

Work Location: In person

Quick Apply

Refine Your Search

provider network configuration specialist jobs in doral fl

Provider Network Configuration Specialist

Network Specialist 1, Full-Time, Nights, Tuesday - Thursday 8:30pm-7:00am and Friday 10:30pm-9:00am

IT Support Specialist

Benefits Specialist

Healthcare Configuration and Data Integrity Manager

IT Specialist

Onsite AV/IT Engineer

RCM Contract Support Specialist

Technical Support Specialist - Level II

Microsoft Identity Entra ID Senior Consultant

Specialist, Media Operations

RCM Contracts Manager

Manager of End User Computing (EUC) & Client Architecture

Verkada Architect

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