2-5

Healthcare Configuration and Data Integrity Manager

2/2/2026

The Configuration and Data Integrity Manager is responsible for managing claims, provider configuration, and database management. They ensure data integrity and collaborate with various departments to support configuration processes.

Working Hours

40 hours/week

Company Size

51-200 employees

Language

English

Visa Sponsorship

About The Company

Provider Network Solutions (PNS) is the market leader and innovator in Specialty MSO and Third-Party Administrative services, managing Governmental and Commercial lines of business to align Health Plans, Primary Care Physicians, and Specialists in a comprehensive ecosystem. PNS optimizes the delivery of specialty healthcare, guided by advanced analytics and an NCQA Accredited UM Program while adhering to regulatory requirements and information systems security guidelines. Our Health Plan and Provider partners benefit from over 30 years of specialty risk management expertise. PNS’s mission is to be the Premier Value-Based Specialty Ecosystem organization, which provides our Health Plan partners with a Specialty network of providers who ensure quality patient care through compassion while adhering to “Best Practice” guidelines. We strive to enhance our Specialists with greater access to patients seeking their service while maintaining complete data integrity and a robust security platform. Our culture promotes an environment where individuality and diverse mindsets collaborate and inspire each other to be better. Our enthusiastic and invaluable team members are encouraged and empowered to create reliable top-drawer solutions, not only for our internal but for our external stakeholders as well. Our core values and purpose-driven mindset fostering continuous and never-ending improvement, (C.A.N.I.) are evident and palpable throughout our organization and kept alive by our team. PNS is a company where you will be embraced by colleagues who want to see you grow in an environment that will inspire you to become the very best version of yourself. For Career opportunities visit us at: https://www.providernetworksolutions.com/careers/ We are always eager to meet fresh talent. Here, at Provider Network Solutions, you’ll do more than join an organization— you’ll become part of the family. There is a place here for every kind of brilliant.

About the Role

Description

Position Summary

The Configuration and Data Integrity Manager is responsible for implementing and interpreting the organization's overall claims, provider configuration, eligibility and provider database management, security, and operations. The Configuration Manager will work with internal departments and external organizations to assure secure data exchanges, integrity, reliability, and availability; plans, organizes and coordinates activities related to the analysis and implementation of network database systems; provides technical guidance and database compliance audits; and consults with business users regarding the use and management of data.

Duties and Responsibilities

• Responsible for benefit configuration covered services, copay, deductibles, coinsurance and max out of pocket in TPA system. Ensure mapping and testing behind the scenes and maintain Matrix of Benefit Packages

Responsible for provider records configuration and contract rate load create vendors, practice locations, medical group, networks, reimbursement rate. Collaborate with Provider Relations Department and Credentialing to ensure Responsible for work distribution and resource management of configuration specialist and data integrity specialist.

• Configuration support to provider contracts-question if specific agreement received can be entered as noted.

• Conduct unit testing to ensure design meets specifications as it relates to product upgrades or new releases.

• Responsible for accurately interpreting specific contracts as well as additional business requirements and converting these terms to configuration parameters.

• Quality control of all information uploaded in TPA system, i.e., Provider data, fee schedules, network assignment, team member’s responsibilities.

• Collaborate with provider call center, clinical and claims department when asked to verify specific provider configuration or benefit configuration information.

• Provide system configuration support to organization based on changing business needs.

• Review and recommend changes to existing configuration processes.

• Analyze and resolve Claims Workflow regarding Benefit & Contract configuration issues in a in with 3 business days.

• Provide technical guidance to Data Integrity Specialist in their assigned job duties.

• Oversee Configure Medicare/Medicaid/Commercial interest rates in TPA system.

• Resolve Eligibility Issues with Health Plans.

• Validate reports ran by Data Integrity Specialist on a weekly, monthly, and quarterly basis.

• Load and Maintain Fee Schedule in TPA System

• Act as liaison between Corporate and the health plan regarding programming development needs related to reporting.

Requirements

Knowledge

• 3-5 years of Claims Processing experience.

• 1-2 years’ experience in healthcare data management.

• Broad knowledge of medical terminology, customer service, claims processing and/or customary and reasonable cost containment, and coordination of benefits and diagnosis coding.

Skills

• Advanced knowledge of Microsoft applications: Outlook, access database, excel, word and basic computer navigation.

Key Skills

Claims ProcessingHealthcare Data ManagementMedical TerminologyCustomer ServiceCoordination of BenefitsDiagnosis CodingMicrosoft ApplicationsData IntegrityConfiguration ManagementTechnical GuidanceQuality ControlCollaborationProblem SolvingTestingReportingResource Management