Position: Network Management Manager Provider Data Maintenance\n
Location: Remote (Must reside in NY\/NJ\/CT)\n
Schedule: Monday - Friday 9am-5pm\n
Compensation: $102,600 - $115,400 annual salary\n
Summary:\n
The Network Provider Data Maintenance Manager will be required to oversee and manage the Data Maintenance Team performance, coordinating and managing all aspects of critical provider information on all claims and provider databases. This includes synchronizing data among multiple systems and applications, ensuring business rules are set and enforced. Collaborate with all needed parties to ensure adherence to business and system requirements of customers as it pertains to contracting, network management and credentialing. Manages the development, implementation, and maintenance of provider data in the provider data system. The Network Management Provider Data Maintenance Manager interfaces with the Provider Contracting Department, Provider Network Operations Department, Credentialing Department, Claims Department, Provider Relations Team, and other ancillary departments (e.g., Claims) to develop data integrity to support effective network operations and strategies for provide data maintenance under the direction of the Director of Network Ops. Organizational expert in responding to regulatory reporting around provider data. Engages IT and other departments to implement changes to business rules with the support of the Network Ops Director. The Manager will be responsible for Provider Maintenance special projects, reviewing contracts, letters of agreement and amendments for implementation, in addition to creating, or updating provider and(or) vendor records, and working closely to assist Provider Network Operations staff on provider data related issues and strategies. The Network Provider Data Maintenance Manager must have experience in data analytics , experience with Cognizant and Health Cloud.\n
Essential Job Functions:\n\nCreation and maintenance of all provider records within the health plan system(s) includes:\nLeader in demographic data migration to V12\/Salesforce \nParticipates in all implementation aspects and directs team on all responsibilities for success\nLeader in demographic interface for claims adjudication and payment w\/vendor (ILS\/Cognizant)\nManages in partnership with finance the EFT set up \/process ; ensuring EFT info is set up and shared with \nManages and oversees Data Team roles and \nManage the daily data migration from delegated rosters to the provider platform, V12.\nSetup of demographic and specialty information, panel, line of business and fee schedules\nPerforms data entry accurately and \nAudit current provider contracts and data to ensure they are up to date.\nAct as subject matter expert for other departments as it relates to provider contracts and \nTrouble shoot and identify root cause of problems and collaborate with other departments to resolve provider data \nIdentifies and documents opportunities for provider education and communicates to network \nParticipates in standing meetings as necessary, including but not limited to provider relations, contracting, network development, team building, network \nWork to create most effective provider maintenance reports and ensure they are assigned the correct \nPrepares correspondence to providers concerning their provider data issues and requests for more \n\n
Provider Data Coordination\n\nManage new contracts, amendments, LOAs implementation to support organization and \nWork with Provider Contracting Department, Provider Network Operations, Credentialing Department, Claims Department, and\/or other ancillary department or vendors to resolve contract configuration discrepancies in a timely \nAssign standard and new custom templates to respective provider records.\nAssist in resolving escalated provider issues from Senior Management\nReceive, coordinate, and manage requests submitted to\/from IT Department, Claims Department, or other \nCommunicate with cross departmental representatives to address provider data \nAssist in the implementation of changes to the provider file and corresponding \nConduct\/coordinate testing of all Contract\/Provider changes and verify results prior to a move to \nCommunicate with providers and vendors to secure supporting documents for creating and maintaining \nDevelop and document processes and \n\n
Provider Data Analysis\n\nReceives and reviews provider network updates to support changes to network \nAnalyze, organize, and maintain records to ensure the most updated provider data is \nSummarizes and report findings to ensure follow-up action items are resolved \nDetermine gaps in provider data and develop reporting and solutions to rectify provider data issues\n\n
Qualifications & Minimum Requirements\n\nThis position requires a minimum of 10 years' progressive experience in Managed Care, specifically Medicare and Medicaid working closely with provider network \nThis position requires a minimum of 3 years' experience managing \nExperience in Sales Force, SQL proficiency, Proficiency with MS applications, including but not limited to Word, Excel, Access and \nAnalytical and problem-solving skills including ability to multitask with a strong focus on follow through and attention to detail.\nAbility to adapt to changes in a fast-moving \nMust be able to work independently and as part of a team to complete assigned \nExcellent communication skills both oral and written\n\n
VillageCare is an Equal Opportunity Employer.