Manager, Provider Data Operations

•Manage day-to-day operations of direct reports to ensure goals and departmental tasks are carried out
•Continually review data entry processes; implementing process improvements to ensure effectiveness when appropriate
•Participate in key committees, subcommittees, and/or work groups, as necessary
•Develop and implement processes to monitor key metrics to ensure accuracy of data, process efficiency & staff performance
•Develop departmental training and evaluation techniques
•Responsibility for maintaining all provider networks
•Provide back-up services to departmental positions, as needed
•Ensure timely processing of provider networks and maintenance activities
•Manage network requirements for RFA ‘s / RFP’s
•Perform basic metrics analysis related to provider networks, claims processing and other related operational performance
•Provide leadership and direction for the multi-state, multi-product teams across internal and external databases
•Manage the relationship with IT as required for implementation of initiatives for process improvement through automation within Health Partner Life Cycle (HPLC)
•Perform cost-benefit and return on investment analyses for proposed initiatives to aid decision-making process as well as collect and analyze data in support of business case creation and realization
•Perform research into quality, grievance, fraud and abuse or malpractice issues for providers as needed
•Ensure HPLC activities comply with URAC, NCQA, state and federal regulations
•Coordinate, produce and analyze management reports and incorporate changes as requested to enhance reporting and/or improve workflow and monitor for trends and patterns
•Communicate with and provide regular updates to Senior Leadership
•Demonstrate strong commitment to stakeholder relationships by taking ownership of issues and facilitating effective outcomes in a timely manner
•Perform any other job related instructions, as requested

Education / Experience:

  • Bachelor of Science degree in business related field or equivalent years of relevant work experience is required
  • Minimum of five (5) years of experience in a healthcare environment is required
  • Experience in Provider Services is preferred
  • Minimum of three (3) years leadership experience is preferred

Required Competencies / Knowledge / Skills:

  • Ability to make decisions & problem solve
  • Ability to manage & prioritize multiple tasks
  • Proficient with Microsoft Office to include Word, Excel and PowerPoint
  • Excellent written and verbal communications skills
  • Ability to develop, prioritize and accomplish goals
  • Detail oriented
  • Strong interpersonal skills and high level of professionalism
  • Effective listening and critical thinking skills
  • Effective problem solving skills with attention to detail

Licensure / Certification:

  • None

Working Conditions:

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

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