Provider Data Management Specialist 2 (Hybrid)

Overview

The Provider Data Management Specialist 2 ensures complex provider, practitioner, contract, and demographic data is accurate, complete, timely, and compliant. This position supports critical operational functions including provider contracting, claims adjudication, credentialing and privileging coordination, referrals, provider directory accuracy, regulatory reporting, network adequacy, and member access. This role requires advanced data interpretation, contract and business-rule analysis, source-system configuration judgment, and understanding of downstream data dependencies to ensure provider data is accurate and aligned with organizational, contractual, and regulatory requirements.

Key Responsibilities

- Collect, analyze, validate, interpret, and maintain contracted data elements, provider information, and practitioner demographics to support contracting, claims processing, credentialing, referrals, regulatory compliance, network adequacy reporting, and directory accuracy.

- Apply critical thinking to synthesize contract terms, business rules, data architecture, practitioner affiliations, credentialing requirements, and regulatory standards to ensure accurate data configuration in source and downstream systems.

- Conduct proactive outreach and follow-up with contracted providers to obtain, clarify, and validate required provider data in accordance with business rules, internal data quality standards, and regulatory or operational turnaround-time requirements.

- Research, document, and resolve provider inquiries, data discrepancies, and other complex provider data issues while maintaining collaborative provider relationships, communicating requirements and resolution status, educating providers on processes, coordinating with internal stakeholders, and escalating service or operational concerns as appropriate.

- Validate provider-submitted data through approved verification platforms and internal controls to ensure adherence to data integrity, compliance, and audit-readiness requirements.

- Contribute to data reconciliation and remediation projects to maintain the integrity of contracted provider and practitioner demographic data.

- Research and resolve claims issues related to contracted provider demographic data.

Minimum Qualifications

- Associate degree or equivalent experience in data management or data analytics.

- 3+ years of experience managing provider demographic data.

- Strong analytical, problem-solving, organizational, and communication skills.

- Experience with data quality management, regulatory requirements, and provider contracting processes.

- Proficiency with Microsoft Office and the ability to learn new systems quickly.

Preferred Qualifications

- Bachelor's degree in business, healthcare, or a related field.

- 5+ years of provider data management experience.

- Advanced knowledge of applicable laws, regulations, and accreditation standards (e.g., NCQA, CMS).

- Strong data analysis and process improvement skills.

- Ability to work effectively with providers, leadership, and cross-functional teams.

For more information about this position, contact Courtney Johnson, [email protected]. About Northwest Permanente: We are the Permanente in Kaiser Permanente. Northwest Permanente is a self-governed, multi-specialty group of 1,500 physicians, clinicians, and administrative professionals caring for more than 600,000 members in Oregon and Southwest Washington. Together with Kaiser Foundation Health Plans and Kaiser Foundation Hospitals, we form Kaiser Permanente of the Northwest, an integrated health care program. Kaiser Permanente is one of the nation's pre-eminent health care systems, a benchmark for comprehensive, integrated, value-based, and high-quality care.Our Northwest Permanente administrative professionals enjoy a wide range of company sponsored benefits:

- 15% employer contribution to retirement programs, including pension.

- 90% employer-paid health plan

- Tuition Reimbursement

- Child Care Benefits

- Flexible Work Schedules

- Paid Parental Leave

- Self-Care Days + Paid Time Off

Equal Opportunity Employer Northwest Permanente is an equal opportunity employer committed to fair, respectful, and inclusive workplaces. Applicants will be considered for employment without regard to race, religion, sex, age, national origin, disability, veteran status, or any other protected characteristic or status.