Candidate must live in one of the following states: AZ, D.C., DE, FL, GA, IN, IA, KS, MD, MI, NC, PA, TX, VA, WV

Position Summary: 

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

About Maryland Care Management, Inc. (MCMI):

Maryland Care Management, Inc. (MCMI) manages Maryland Physician Care’s (MPC) statewide provider network of hospitals and physicians. Maryland Physicians Care has been providing services to the HealthChoice Medicaid populations since 1996, and we are proud of our footprint in the community. With over 230,000 members, MPC consistently has been one of MD’s largest Medicaid-managed care organizations.

Why join us?

MCMI recognizes the importance of flexibility and offers multiple work arrangements. Along with competitive pay, we offer excellent benefits (medical, dental, and vision plans, 100% employer Term Life Insurance, Short and Long-Term Disability, 401k Employer Match up to 4%) as well as 20 days of PTO, and tuition assistance/professional development plans. Your future colleagues at MCMI are welcoming, friendly, and eager to help each other succeed. We are committed to Diversity, Equity, and Inclusion, providing organizational-wide social opportunities, and constantly improving our ongoing efforts to positively impact our members’ lives.

What You’ll Do: 

• Manage the end-to-end provider data entry and maintenance to ensure accurate and timely setup for claims payment, member assignment, and directory display.
• Train, mentor, and conduct constructive and timely performance evaluations for PDM staff.
• Monitor/review providers’ and facilities’ data and rosters in applicable systems ensuring accuracy/compliance.
• Investigate and resolve escalated PDM inquiries and complaints.
• Develop, implement, and communicate knowledge-based documents and procedures to staff.
• Produce daily, weekly, monthly, and annual productivity reports as needed.
• Facilitate meetings with providers and Health Plan representatives.
• Ability to handle Protected Health Information following the Health Insurance Portability and Accountability Act (HIPAA).
• Continues education regarding change and trends in health care management and specific provider communications.

Knowledge and Skills:

• Demonstrated experience with Microsoft Office 365 to include proficient and successful utilization of Word, Outlook, Teams, and Adobe applications.
• In-depth knowledge of systems development life cycle and/or operational maintenance environment.

Education and Work Experience:

• Associate’s degree in a related field or 2 years of relevant experience.
• 3 years of provider data management/credentialing, data analysis, and customer service experience with healthcare operations (i.e., provider relations, or contracting)
• 1 year of management experience.
• Experience performing and managing teams performing data analysis in Excel or similar tools preferred.
• Experience in a managed care, insurance, or medical office environment preferred.

Positions Reporting:

Provider Data Specialists

EEOC Statement: 

Following applicable federal, state, and local laws, MCMI prohibits discrimination in employment based on race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), national origin, age, disability, genetic information, or any other characteristic protected by law. This commitment extends to all aspects of employment, including hiring, promotion, compensation, benefits, training, social and recreational programs, and all other conditions and privileges of employment. 

As a healthcare organization, we recognize the vital importance of inclusivity in delivering quality care to our patients. We strive to foster an environment where individuals of all backgrounds feel respected, valued, and supported. We aim to better comprehend the unique needs of our patients and provide healthcare services that are culturally competent and sensitive. 

We encourage candidates from all backgrounds to apply and join us in our mission to provide compassionate and inclusive healthcare. We believe that a diverse workforce enriches our organization and allows us to better understand, connect with, and serve our diverse patient population.