Provider Data Representative

Type of Requisition:

Regular

Clearance Level Must Currently Possess:

None

Clearance Level Must Be Able to Obtain:

None

Public Trust/Other Required:

MBI (T2)

Job Family:

Ancillary Health

Job Qualifications:

Skills:

Data Integrity, Data Quality, Document Revision, Operations Processes

Certifications:

None

Experience:

3 + years of related experience

US Citizenship Required:

No

Job Description:

The Provider Data Representative maintains accurate provider demographic, participation, credentialing, enrollment, roster, and directory information across all systems supporting the World Trade Center Health Program (WTCHP).

The role ensures provider data integrity to support accurate claims payment, credentialing compliance, provider directory accuracy, and network participation. The Representative partners with Provider Relations, Credentialing, Provider Data, Claims Operations, and Contracting to keep provider information complete, accurate, timely, and compliant with organizational standards.

Key Outcomes & Success Metrics

• Directory accuracy & completeness: Meet internal standards and regulatory expectations; reduce member/provider complaints due to directory errors.
• Maintenance timeliness: Process updates, additions, terminations, and changes within SLAs; reduce cycle time and backlog.
• Data integrity: Improve audit scores; lower claims‑impacting data error rates; maintain accurate NPIs, TINs, specialties, practice locations, affiliations, licenses, and EFT details.
• Roster reconciliation effectiveness: Validate rosters against credentialing, enrollment, terms & conditions, claims, and directory data; correct discrepancies promptly.
• Credentialing & enrollment support: Ensure data readiness for onboarding and recredentialing; reduce participation activation delays.
• Operational reporting: Provide clear dashboards and logs for productivity, turnaround times, accuracy, and issue remediation.

Essential Duties & Responsibilities

Data Intake & Maintenance Operations

• Process provider roster submissions and updates.
• Maintain accurate provider demographic, enrollment, and participation records.
• Validate and update NPIs, TINs, specialties, practice locations, EFT details, and affiliations.
• Ensure timely changes supporting accurate claims payment and directory publication.

Roster Reconciliation

• Reconcile provider rosters against credentialing, claims, enrollment, and directory systems.
• Identify discrepancies impacting participation, claims payment, or directory accuracy.
• Coordinate corrections with Provider Relations, Credentialing, and Provider Data teams.

Credentialing & Enrollment Support

• Validate provider demographic information for credentialing/recredentialing.
• Identify and resolve enrollment and participation discrepancies.
• Ensure data requirements are complete for onboarding and participation activation.

Data Quality & Governance

• Audit provider records for completeness, accuracy, and compliance.
• Monitor directory accuracy, quality scores, and claims‑impacting error rates.
• Support development of data standards, QA programs, and process improvements.

Claims & Operational Support

• Identify provider data issues affecting claims adjudication, reimbursement, and participation.
• Collaborate with Claims Operations to resolve data discrepancies; support root‑cause analysis and remediation.

Reporting & Analytics

• Produce provider data quality reports, discrepancy logs, and audit results.
• Track maintenance productivity, turnaround times, and accuracy metrics.
• Provide insights to leadership to guide operational improvements.

Provider & Stakeholder Communication

• Communicate data requirements and discrepancies to credentialing, enrollment, and provider relations teams.
• Provide clear documentation for provider updates and requests.

Process Improvement & Tooling

• Recommend system enhancements, automation opportunities, and updated workflows.
• Support implementation of new processes, templates, and operational tools.

The likely salary range for this position is $46,325 - $62,675. This is not, however, a guarantee of compensation or salary. Rather, salary will be set based on experience, geographic location and possibly contractual requirements and could fall outside of this range.

Scheduled Weekly Hours:

40

Travel Required:

Less than 10%

Telecommuting Options:

Remote

Work Location:

USA VA Falls Church

Additional Work Locations:

Total Rewards at GDIT:

Our benefits package for all US-based employees includes a variety of medical plan options, some with Health Savings Accounts, dental plan options, a vision plan, and a 401(k) plan offering the ability to contribute both pre and post-tax dollars up to the IRS annual limits and receive a company match. To encourage work/life balance, GDIT offers employees full flex work weeks where possible and a variety of paid time off plans, including vacation, sick and personal time, holidays, paid parental, military, bereavement and jury duty leave. To ensure our employees are able to protect their income, other offerings such as short and long-term disability benefits, life, accidental death and dismemberment, personal accident, critical illness and business travel and accident insurance are provided or available. We regularly review our Total Rewards package to ensure our offerings are competitive and reflect what our employees have told us they value most.

 

 

Our Identity Verification Process:

As part of the hiring process, we will ask you to complete an identity verification process that leverages advanced biometrics and artificial intelligence to ensure authenticity and protect against identity fraud. You are expected to be on camera during virtual interviews. We reserve the right to take your picture to verify your identity and prevent fraud. By proceeding, you authorize the collection, processing, and use of your biometric data for identity verification and security purposes.

 

 

About Our Work:

We are GDIT. A global technology and professional services company that delivers technology solutions and mission services to every major agency across the U.S. government, defense and intelligence community. Our 26,000 experts extract the power of technology to create immediate value and deliver solutions at the edge of innovation. We operate across 50+ countries worldwide, offering leading mission-ready capabilities in AI, cloud, cyber and software development.

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Equal Opportunity Employer / Individuals with Disabilities / Protected Veterans