Business Process SME - Provider Data Management

Hi Professional,

Our client is looking for Business Process SME – Provider Data Management project in East Brunswick, NJ below is the detailed requirements.

Job Title : Business Process SME – Provider Data Management

Location : East Brunswick, NJ

Duration : Long Term

Description:

• Bachelor's degree or Master’s Degree in Computer science, or a related field, with minimum 12+ years of experience.


• 15+ years of experience in Healthcare Payer Operations, with 10+ years in Provider Data Management.


• Strong expertise in end-to-end provider lifecycle and provider data governance.


• Good Experience managing provider onboarding, setup, maintenance, termination, and directory updates.


• Must be Expertise in credentialing, recredentialing, PSV, sanction monitoring, and NCQA/CMS compliance.


• Strong knowledge of provider contracting, network management, and provider roster management.


• You should have Experience with FFS, capitation, Value-Based Care, shared savings, and risk-sharing models.


• Good Knowledge of provider pricing configuration, fee schedules, rate loading, and reimbursement.


• Must have a Experience analyzing provider contract impacts on claims adjudication and payment accuracy.


• You should be Skilled in requirements gathering, process mapping, SOPs, business process reengineering, and stakeholder management.


• Experience with Facets Provider Module, UHC/Optum, NDB, NICE, Salesforce, or similar platforms is preferred.

With Regards

Rajkumar,

Lorven Technologies, Inc.

101 Morgan Lane | Suite 209 | Plainsboro | NJ 08536

Tel: -609-799-4202 * 247 | Fax:609-918-4204

Email: raj.k@lorventech.com| Web: www.lorventech.com