Job ID: FL-DMS-2425-313-1 (99590514)
Remote/Local Healthcare (must) Network Engineer (15+) with AI automation, CAQH/NPPES/NCQA/CMS experience
Location: Tallahassee, FL (DOH)
Duration: 12 Months
JD 1: Healthcare Provider Data Domain Expert (Non-Technical)
Purpose:
Bring real-world understanding of how provider data flows from providers to payers. Help the tech team avoid bad assumptions and define what’s practical when designing AI and dual-system workflows.
Key Responsibilities:
• Explain how provider data typically flows from:
o Individual providers, group practices, CAQH, NPPES → to payers.
• Outline how payers (like Healthfirst) process and validate this data.
• Define real-world provider lifecycle events:
o Onboarding, re-credentialing, terminations, address/specialty updates.
• Identify common operational pain points:
o Duplicates, outdated credentials, slow syncs, mismatches across systems.
• Help assess what AI can realistically automate vs. where human judgment is required.
• Validate assumptions in the solution design and flag compliance or usability concerns.
Must-Have Skills:
• working in provider data operations or credentialing at a health plan, MSO, or vendor.
• Deep knowledge of CAQH workflows, NPPES, NCQA/CMS directory requirements.
• Familiarity with how provider data is consumed downstream (CRM, Claims, Portals).
• Strong communication skills to advise engineers clearly on edge cases and operational reality.
F-Resume-Self-Certification-Form.docx