Job Description

Summary/Position Objectives:

Supervises the day-to-day operations of the Provider Data Management (PDM) team. The Supervisor ensures the teams’ productivity and quality service measures are met, tools and procedures are current and coordinates departmental activities, including training, scheduling, and performance management. The Supervisor will oversee and assist PDM employees in the performance of their job duties such as entering in Provider data into the Provider management source system, managing provider demographic data workflows, and validations.

Responsibilities: 

Essential Functions:

• Ensures that business goals, deadlines and performance standards are met.
• Manage the end-to-end provider data entry and maintenance to ensure accurate and timely setup for claims payment, member assignment and directory display.
• Conducts performance evaluations that are timely and constructive.
• Monitors or reviews providers or facilities data and rosters in applicable systems ensuring accuracy.
• Investigate and solve escalated PDM inquiries and complaints.
• Develops and implements knowledge-based documents and procedures and explains these to staff.
• Identify trends and recommend improvements to mitigate potential issues.
• Produces daily, weekly, monthly, and annual productivity reports as needed.
• Store and organize all relevant provider documents.
• Lead task assignment for team’s workflow and distribution
• Monitor team performance to ensure established and provider data quality benchmarks are met.
• Facilitate meetings with providers and Health Plan representatives.
• Train and mentor PDM Staff
• Send out provider applications, forms and other provider correspondence as requested.
• Ability to handle Protected Health Information in a manner consistent with the Health Insurance Portability and Accountability Act (HIPAA).

Secondary Functions:

• Works in a manner that is not disruptive to peers, senior leadership and/or subordinates.
• Must maintain regular and acceptable attendance at such level as is determined in the employer’s sole discretion.
• Must be available and willing to work such days and hours as the employer determines are necessary or desirable to meet its business needs.
• Maintains professionalism to include phone etiquette, manners, appearance, and attitude.
• Maintains effective working relationships with various providers, networks, and managed health care components.
• Continues education regarding change and trends in health care management and specific provider communications.
• Performs other duties as assigned.

Knowledge and Skills:

• Work requires demonstrated experience with Microsoft Office 365 to include proficient and successful utilization of Word, Outlook, Teams, and Adobe applications.
• Experience performing and leading teams performing data analysis in Excel or similar tools strongly preferred.
• In-depth knowledge of systems development life cycle and/or operational maintenance environment required.
• Strong problem-solving and the ability to use reason to define problems, collect data, establish fact, draw valid conclusions and design, implement, and manage appropriate action plans to meet deadlines.

·       Excellent written, verbal, and interpersonal communication skills to present clear, concise, and accurate information; ability to facilitate meetings, manage diverse groups, and build relationships with employees, internal business partners and external customers.

• Ability to multitask, organize, and coordinate work priorities in a demanding environment.

Education and Work Experience:

• Associate’s degree in related field or equivalent experience.
• 3 years of provider data management/credentialing, data analysis, and customer service experience preferably with healthcare operations (i.e., claims processing, billing, provider relations or contracting) experience in a managed care, insurance, or medical office environment preferred.
• 1 year of leadership experience preferred.

Positions Reporting:

None

How to Apply

Job Categories: Equal Opportunities. Job Types: Full-Time. Salaries: 60,000 - 80,000.

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