Manager, Provider Data Management

🕒 Julho 22

🌽 Illinois – Remoto

🌽 Illinois – Remote

💵 $70.100 - $126.200 / ano

⏰ Tempo Integral

🟡 Pleno

🟠 Sênior

👔 Gerente

👻 Score fantasma 22%

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Centene Corporation

SiteLinkedInTodas as Vagas

10.000+ funcionários

Fundada em 1984

🛡️ Seguros

💼 Consultoria

🏥 Saúde

Insurance • Consulting • Healthcare

Centene Corporation é uma provedora líder de serviços de saúde patrocinados pelo governo, especializada em oferecer soluções de saúde acessíveis e de alta qualidade. Há mais de 40 anos, a Centene tem se dedicado a transformar a saúde das comunidades, ampliando o acesso a Medicaid, Medicare e ao Health Insurance Marketplace, além de atender comunidades militares por meio do programa TRICARE. Como a maior organização de managed care do Medicaid e participante-chave no Marketplace, a Centene enfatiza a entrega de cuidados de saúde com foco local, combinada a parcerias sólidas com organizações sem fins lucrativos para atender às necessidades únicas de seus membros. A Centene também é comprometida com sustentabilidade corporativa e responsabilidade social, priorizando a gestão ambiental e a governança ética para promover o bem-estar das comunidades que atende.

Descrição

• Lead inventory, quality, production, and employee development within the Illinois Health Plan • Manage provider data management projects, policies, procedures, and provider contract setup activities • Support provider data maintenance, claims adjudication, directory accuracy, and other operational projects • Partner with Credentialing to set up and maintain delegated entity arrangements • Oversee development of reports supporting strategic and operational departmental requirements • Identify and implement value-added programs and initiatives supporting network contracting and operational efficiency • Serve as main contact for internal departments on provider, contract, and claims application changes • Meet with internal departments to identify project requirements and ensure satisfactory completion • Work with the Information Systems Department on special projects • Supervise staff and direct and monitor staff activity • Conduct reviews and one-on-ones, and provide monthly performance statistics • Monitor quality scores, production scores, and production turnaround times • Maintain working knowledge of provider data management, provider reimbursement, and claims processing applications • Develop cost-benefit analyses for project prioritization and justification • Develop and update policies, procedures, manuals, and training with internal departments • Lead meetings about new workflows, policies, and procedures • Conduct training for internal and external departments on provider data services policies and procedures • Resolve issues related to contract or policy interpretation • Define reporting and information initiatives with internal and external customers • Perform ad-hoc reporting and prioritize data analysis projects • Maintain provider data integrity guidelines for delegated credentialing vendors • Design and develop workflows, protocols, and process models for standard and ad-hoc reports • Maintain, test, and revise data analysis programs • Manage input data from internal and external sources • Comply with all policies and standards and perform other duties as assigned

🎯 Requisitos

• Bachelor’s degree required in business administration, Health Care, or a related field • 1-3 years management experience in a business setting required • Minimum 3 years’ experience working in a health care setting • Preferably background in provider relations, provider data services, information technology or claims operations • Experience developing new business processes and procedures • Strong history of leadership roles with direct reports • Proficient in Microsoft Office Suite, especially Excel, Visio, and Word • Good communication and meeting facilitation skills • Knowledge and experience working with Portico, Amisys, Directory, and other provider-related systems • Must be authorized to work in the U.S. without employment-based visa sponsorship now or in the future • Must be available for Central time (CST) working hours • 10% travel requirement

🏖️ Benefícios

• Competitive pay • Health insurance • 401K plan • Stock purchase plans • Tuition reimbursement • Paid time off plus holidays • Flexible approach to work with remote, hybrid, field or office work schedules • Additional forms of incentives may be included in total compensation • Equal opportunity employer committed to diversity