Business Process SME - Provider Data Management
Job in
East Brunswick, Middlesex County, New Jersey, 08816, USA
Listed on 2026-10-18
Listing for:
Lorven Technologies Inc.
Full Time
position Listed on 2026-10-18
Job specializations:
-
IT/Tech
Data Analyst, Business Systems & Technology Analysis
Job Description & How to Apply Below
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: -
* 247 | Fax:
Email: | Web:
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