Manager, Health Partner Data Reconciliation

Role and Responsibility:
•Perform supervision and support of the Health Partner Lifecycle (HPLC) Data Reconciliation team members
•Develop and manage all processes related to inbound and outbound provider data files
•Responsible for accurate and timely updates to data exceptions
•Provide direction and oversight of business processes to ensure accurate setup and maintenance of defined provider information in applicable systems, and ensure compliance with provider contract documents
•Maintain subject matter expertise of all supported provider data files
•Assure that data entry activities are accurate, timely, and compliant with state and regulatory standards
•Develop, document and perform testing and validation as needed for process and system changes
•Serve as primary point of contact for vendors and business partners that are sending and receiving CareSource provider data
•Coordinate efforts with markets and other CareSource departments to ensure all data needs are met
•Actively participate in the Operations Management Team and meetings
•Conduct performance evaluations, hiring, and disciplinary action decisions
•Conduct root cause analysis on escalated issues
•Coordinate data entry activities related to assignments, problem solving, and project management
•Supervise staff for quality review, performance feedback, disciplinary issues, and merit/bonus appraisal review
•Create, review, revise, and enforce company and departmental policies and procedures
•Provide mentoring, training, and ongoing education in regards to optimal performance and Standards of Excellence
•Perform any other job related instructions, as requested

Education / Experience:
•Bachelor’s Degree in business, healthcare or related field or equivalent years of relevant work experience is required
•A minimum of three (3) years of experience in data analysis and/or root cause analysis required
•A minimum of three (3) years of experience working with operations or IT is required
•A minimum of three (3) years of experience in a leadership role is required
•Experience working with provider data preferred
•Experience working with Excel, SQL, and Microsoft Access preferred

Required Competencies / Knowledge / Skills:
•Advanced computer skills, specifically working with data
•Proven understanding of business process
•Proven critical thinking and analysis skills
•Experience writing and/or interpreting system requirements preferred
•Communication skills
•Ability to work independently and within a team environment
•Training/teaching skills
•Attention to detail
•Ability to effectively support diverse personalities and work styles
•Familiarity of the healthcare field
•Knowledge of Medicaid
•Critical listening and thinking skills
•Strategic management skills
•Use of proper grammar
•Technical writing skills
•Time management skills
•Proper phone etiquette
•Customer service oriented
•Decision making/problem solving skills
•Knowledge of medical terminology
•Ability to identify and recommend process improvements

Licensure / Certification:

Working Conditions:
•General office environment; may be required to sit/stand for long periods of time

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