Provider Data Specialist in Walnut Creek, California at Paradigm

Paradigm is an accountable specialty care management organization focused on improving the lives of people with complex injuries and diagnoses. The company has been a pioneer in value-based care since 1991 and has an exceptional track record of generating the very best outcomes for patients, payers, and providers. Deep clinical expertise is the foundation for every part of Paradigm’s business: risk-based clinical solutions, case management, specialty networks, home health, shared decision support, and payment integrity programs.

We’re proud to be recognized—again! For the fourth year in a row, we’ve been certified by Great Place to Work®, and for the third consecutive year, we’ve earned a spot on Fortune's Best Workplaces in Health Care™ list. These honors reflect our unwavering commitment to fostering a positive, inclusive, and employee-centric culture where people thrive.

Watch this short video for a brief introduction to Paradigm.

Paradigm is seeking a full-time, fully remote Provider Data Specialist. The schedule for this position is Monday - Friday, 8 AM to 5 PM, 9 AM to 6 PM, or 10 AM to 7 PM.

The Provider Data Specialist is responsible for collecting, verifying, maintaining, and managing provider credentialing and participation data across multiple systems. This role supports credentialing operations by ensuring accurate, complete, and compliant provider files in accordance with company policies, accreditation standards, and state and federal regulations. The Provider Data Specialist works collaboratively with internal teams and external providers, maintains strict confidentiality of sensitive information, and contributes to reporting and process support that enables efficient network and credentialing operations.

DUTIES AND RESPONSIBILITIES

• Requests, receives, processes participating provider information across multiple databases
• Processes request, investigation, verification, tracking and follow up of primary responses from various sources.
• Identifies, investigates, reports, tracks, and follows-up on any potentially adverse information received from credentialing sources.
• Obtains and maintains appropriate knowledge of company policy and procedures, accreditation standards, state and federal regulations, guidelines, procedures and laws required in credentialing process.
• Populates, updates, and maintains database software and filing systems.
• Assists with Requests for Proposals or any requested reports as necessary and in collaboration with supervisor or other Credentialing Services staff.
• Maintains practitioner files annually.
• Ensures provider credentialing documents are present for affiliated community practitioners.
• Participates in professional organizations and/or other organizations addressing Provider Data
• Maintains strict confidentiality of all records, data and occurrences as condition of initial and/or continued employment.
• Maintain reliable and predictable attendance during scheduled work hours.

QUALIFICATION REQUIREMENTS

• Bachelor's degree in health care or technical field preferred, call center experience a plus.
• Exceptional communication and telephone skills are required, as well as a great deal of patience and understanding.
• Experience working with physicians and/or senior executives preferred.
• Possess a high level of self-confidence and persistence; maintain an assertive approach in dealing with providers.
• Must possess excellent organizational skills and the ability to multi-task effectively.
• Demonstrate the ability to prioritize heavy workload and work independently with minimal supervision.
• Proficient computer and internet skills; familiarity with Microsoft Office software required.
• Knowledge of medical terminology preferred.
• Will develop in-depth knowledge of department and company internal workflows including but not limited to individual state’s procedures and negotiating protocols.
• Bilingual a plus