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Provider Data Consultant

Company: VirtualVocations
Location: Vista
Posted on: May 24, 2025

Job Description:

A company is looking for a Provider Data and Claims Consultant, Remote.
Key Responsibilities

Support behavioral health member and provider operations through pricing integrity audits and provider pick integrity programs
Conduct market audits, analysis, reporting, and remediation as part of a workgroup
Assess provider pick job aids and provide recommendations for rules engine development while acting as operational backup

Required Qualifications

3+ years of data analysis and/or audit experience in the healthcare industry
3+ years of claims analysis and/or claims audit experience
Advanced understanding of UHG provider data, including knowledge of NDB, OHBS Facets, or CSP Facets
Experience leading cross-functional workgroups and defining detailed requirements for automation or user tools
Intermediate proficiency with Microsoft Excel

Keywords: VirtualVocations, Lynwood , Provider Data Consultant, Professions , Vista, California

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