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Business Process SME - Provider Data Management

Lorven Technologies, Inc.East Brunswick, NJ🇺🇸United StatesPosted Oct 15, 2026

Quick Overview

Seniority

Mid Senior

Work mode

Hybrid

Location

East Brunswick, NJ, United States

Posted

4 days ago

Stakeholder Management

Job Description

Job Title : Business Process SME – Provider Data Management
Location : East Brunswick, NJ

Job Description:

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.
Experience managing provider onboarding, setup, maintenance, termination, and directory updates.
Expertise in credentialing, recredentialing, PSV, sanction monitoring, and NCQA/CMS compliance.
Strong knowledge of provider contracting, network management, and provider roster management.
Experience with FFS, capitation, Value-Based Care, shared savings, and risk-sharing models.
Knowledge of provider pricing configuration, fee schedules, rate loading, and reimbursement.
Experience analyzing provider contract impacts on claims adjudication and payment accuracy.
Skilled in requirements gathering, process mapping, SOPs, business process reengineering, and stakeholder management.
Experience with Facets Provider Module, NDB, NICE, Salesforce, or similar platforms is preferred.

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