Provider Data Specialist
Resume:
Edward Silverio
Provider Data Specialist
*** ********* **, *****, *****, 75023, 214-***-****, ***************@*****.*** Professional summary
Provider Data Specialist with a keen eye for detail and a passion for optimizing data processes to enhance operational efficiency. Demonstrates strong communication skills and a collaborative approach in managing provider information, ensuring accuracy and compliance with industry standards. Eager to leverage innovative strategies to drive data management improvements and support organizational growth.
Employment history
Senior Provider Data integrity, Dec 2022 - Jan 2025 Blue Cross Blue Shield of Texas, Richardson, TX
Provider Data Specialist, Apr 2020 - Dec 2022
Blue Cross Blue Shield of Texas, Richardson, TX
Skills
Process Improvement, Project Coordination, Data Validation, Risk Assessment, Problem Solving, Data Analysis, Microsoft, 10 Key.
Education
Aug 2016 - Oct 2016
Eastfield College
Assisted in Behavioral Health projects to add provider practices and Age ranges to their Specific networks Streamlined provider data management processes, enhancing accuracy in Medicare/Medicaid network and Triwest network additions and ensuring compliance with credentialing standards. Spearheaded cross-functional projects, integrating Veteran Affairs provider data with claims systems, improving service delivery for military personnel.
Led team efforts in dental provider data projects, leveraging Excel and automation to efficiently update demographic and network information.
Conducted thorough quality assurance reviews, identifying and rectifying errors to minimise impact on provider claims and network profitability.
Optimised team productivity through strategic work allocation and report management, ensuring timely completion of provider data integrity tasks.
Completed Provider Demographic cases within Salesforce in order to update or add any new information pertaining our providers
Added new providers within the system whether they're solo providers or added to an existing medical group Updated Provider Medical Specialty information
if necessary, directly contacted medicare providers in order to ensure Data accuracy within our system Keyed new Demographic updates Submitted by providers Via Fax or through Availity Managed provider data, ensuring accuracy across multiple systems. Verified NPI and tax ID information using NPPES, and screened for debarments via Bridger.
Worked closely with cross-functional teams to ensure comprehensive provider information updates. Facilitated smooth communication between departments.
Proposed and implemented improvements to provider data verification procedures, reducing errors and enhancing overall data quality.
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