Top 6268 Quality management system Jobs in Hallandale Beach, 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
13d
RCM Physician Practice Educator, BHMG Revenue Management, FT,08:30A-5P
Baptist Health South Florida —Miami, FL
- Multiple hires
- Microsoft Word
- Microsoft Outlook
- Computer literacy
- Wellness program
- Health insurance
Team Lead- Foreclosure & Default Operations
Diaz Anselmo & Assoc. PA —Plantation, FL
- Full-time
- Microsoft Excel
- Microsoft Outlook
- Mid-level
- Opportunities for advancement
Quick Apply
14d
Pharmaceutical Inventory Specialist (Evening Shift)
Ecopharm Returns —Dania Beach, FL
- $17 - $20 an hour
- Part-time
- Background check
- Computer literacy
- Mid-level
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Manager Technology - Project Management Office, Technology & Digital, FT,8:30A - 5P
Baptist Health South Florida —Coral Gables, FL
- $144,738.24 - $188,159.71 a year
- Full-time
- Computer Science
- Engineering
- 3 years
- Wellness program
- Health insurance
13d
Hotel Operations Manager
Palm Holdings —Hollywood, FL
- $59,633.41 - $71,816.58 a year
- Weekends as needed
- Inventory management
- Mid-level
- Hotel
- Health insurance
- Dental insurance
Quick Apply
Warehouse Fulfillment & Shipping Associate
Skin Fitness Therapy —Hallandale Beach, FL
- From $15 an hour
- Part-time
- Warehouse experience
- Computer skills
- In-person
Quick Apply
7d
Tech Support I
Sonny's Enterprises LLC —Tamarac, FL
- Call employer
- Microsoft Outlook
- Research
- Office
- Disability insurance
- Health insurance
14d
Shipping Associate
Ecopharm Returns —Dania Beach, FL
- $19 - $21 an hour
- Full-time
- Ability to walk for extended periods
- High school diploma or GED
- Ability to lift 50 pounds
- Health insurance
- Paid time off
Quick Apply
7d
Remote Contact Center Supervisor
Hotwire Communications, LTD —Fort Lauderdale, FL
- Weekends as needed
- Remote
- Mid-level
- Mentoring
- Leadership
Quick Apply
Quality Administrator
Ontic —Miramar, FL
- Full-time
- Microsoft Excel
- Microsoft Outlook
- High school diploma or GED
- Paid holidays
- Health insurance
9d
Warehouse Associate
Insulation Distributors, Inc. —Pembroke Park, FL
- $18.48 - $23.07 an hour
- Computer literacy
- Forklift
- High school diploma or GED
- Paid holidays
- Disability insurance
Quick Apply
SCOPES DOW Records Manager
CACI —Doral, FL
- $53,100 - $106,300 a year
- Full-time
- Office
- High school diploma or GED
- Organizational skills
- Health insurance
10d
Quality Assurance Associate
CEDENT —Pompano Beach, FL
- Organizational skills
- Associate's degree
- Communication skills
Service Desk Admin I
Space Coast Credit Union —Miramar, FL
- $46,130 - $48,847 a year
- Call employer
- Hybrid work
- Pass drug screening
- US work authorization
- Experience equivalent to degree accepted
- Health savings account
- Disability insurance
Quick Apply
Warehouse Associate - FL
Automotive Keys Group (AKG) —Hollywood, FL
- $16 an hour
- Full-time
- Mid-level
- High school diploma or GED
- Ability to lift 50 pounds
Quick Apply
Warehouse Packer
Dcg holdings llc —Hollywood, FL
- $16 - $22 an hour
- Full-time
- Heavy lifting
- Basic math
- Forklift
Quick Apply
Vending machine stocker
Vending Branding LLC —Miami, FL
- From $30 an hour
- Part-time
- Heavy lifting
- Driver's License
- Warehouse
- Flexible schedule
Quick Apply
1d
Utilization Review Specialist
We Level Up —Pompano Beach, FL
- $50,000 - $90,000 a year
- Full-time
- Remote
- 18 years or older
- CPR Certification
- HIPAA
Quick Apply
Receiving
KW Property Management LLC —North Miami Beach, FL
- $24 an hour
- Spanish
- English
- Organizational skills
Quick Apply

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quality management system jobs near hallandale beach, fl

Provider Network Configuration Specialist

Solis Health Plans -
Doral, FL

Quick Apply

Job Details

Full-time
$25 - $27 an hour
13 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

quality management system jobs in hallandale beach, fl

Provider Network Configuration Specialist

RCM Physician Practice Educator, BHMG Revenue Management, FT,08:30A-5P

Team Lead- Foreclosure & Default Operations

Pharmaceutical Inventory Specialist (Evening Shift)

Manager Technology - Project Management Office, Technology & Digital, FT,8:30A - 5P

Hotel Operations Manager

Warehouse Fulfillment & Shipping Associate

Tech Support I

Shipping Associate

Remote Contact Center Supervisor

Quality Administrator

Warehouse Associate

SCOPES DOW Records Manager

Quality Assurance Associate

Service Desk Admin I

Warehouse Associate - FL

Warehouse Packer

Vending machine stocker

Utilization Review Specialist

Receiving

I want to receive the latest job alert for quality management system in hallandale beach, fl

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