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:

None

Job Family:

Process and Operational Efficiency

Job Qualifications:

Skills:

Collaboration, Customer Problem Solving, Customer Service, Microsoft Applications, Multitasking

Certifications:

None

Experience:

1 + years of related experience

US Citizenship Required:

No

Job Description:

The Provider Data Representative ensures complete, accurate, and timely provider demographic, participation, credentialing, enrollment, roster, and directory information across systems supporting the World Trade Center Health Program (WTCHP). The role safeguards 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 comprehensive, correct, and aligned with program and organizational standards.

Key Responsibilities:

Directory Accuracy & Completeness

• Maintain high accuracy standards for provider directory data.
• Support issue resolution that reduces member and provider complaints arising from directory discrepancies.

Timely Updates & Maintenance

• Process demographic changes, additions, terminations, and updates within service‑level expectations.
• Reduce backlog and improve turnaround time through efficient workflow management.

Data Integrity Management

• Validate and maintain NPIs, TINs, specialties, practice locations, affiliations, licensure, and EFT data.
• Identify and reduce claims‑impacting data error rates; support audit readiness.

Roster Reconciliation

• Reconcile provider rosters against credentialing, enrollment, claims, and directory systems.
• Identify discrepancies affecting participation or claims payment and coordinate timely correction with cross‑functional teams.

Credentialing & Enrollment Support

• Validate provider demographic data required for onboarding, credentialing, and recredentialing.
• Identify and resolve participation or enrollment inconsistencies to ensure timely activation.

Claims & Operational Support

• Identify data issues impacting claims adjudication, reimbursement, or provider participation.
• Partner with Claims Operations to resolve discrepancies and support root‑cause analysis.

Reporting & Analytics

• Generate dashboards, productivity logs, discrepancy reports, and data quality metrics.
• Track turnaround times, accuracy rates, and productivity; provide insights to leadership for continuous improvement.

Provider & Stakeholder Communication

• Communicate data requirements, corrections, and discrepancies to credentialing, enrollment, and provider relations teams.
• Maintain clear documentation supporting provider updates and operational workflows.

Process Improvement & Tooling

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

Required Qualifications

• Bachelor’s degree preferred.
• 3+ years of experience in provider data, credentialing, enrollment, or health plan operations.
• Strong analytical skills and proficiency in Microsoft Excel.
• Exceptional attention to detail and accuracy.

Preferred Qualifications

• Experience supporting federal or government‑sponsored healthcare programs.
• Knowledge of provider directory regulatory requirements and healthcare data standards.
• Experience with provider portals, enrollment systems, or enterprise provider data platforms.

Skills & Attributes for Success

• Data governance and quality management
• Analytical thinking and problem solving
• Process improvement mindset
• Attention to detail
• Strong written and verbal communication
• Collaboration and teamwork

 

 

GDIT IS YOUR PLACE:

• Full-flex work week to own your priorities at work and at home.
• 401K with company match.
• Comprehensive health and wellness packages.
• Internal mobility team dedicated to helping you own your career.
• Professional growth opportunities including paid education and certifications.
• Cutting-edge technology you can learn from.
• Rest and recharge with paid vacation and holidays.

#GDITFedHealthJobs

#GDITWTCJobs

The likely salary range for this position is $72,877 - $98,599. 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:

Any Location / Remote

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. GDIT typically provides new employees with 15 days of paid leave per calendar year to be used for vacations, personal business, and illness and an additional 10 paid holidays per year. Paid leave and paid holidays are prorated based on the employee’s date of hire. The GDIT Paid Family Leave program provides a total of up to 160 hours of paid leave in a rolling 12 month period for eligible employees. 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.

Join our Talent Community to stay up to date on our career opportunities and events at

gdit.com/tc.

Equal Opportunity Employer / Individuals with Disabilities / Protected Veterans