Team Lead, Provider Data Integrity – SQL/Provider Data Experience

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🔥 0 minutes ago

🏈 Ohio – Remote

🏈 Ohio – Remote

💵 $62.7k - $100.4k / year

⏰ Full Time

🟠 Senior

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CareSource

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 30+ years

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

CareSource is a health services company focused on providing affordable health insurance and healthcare solutions. It offers a wide range of plans including Medicaid, Marketplace, and Medicare Advantage, targeting low-income adults, families, children, pregnant women, elderly adults, and people with disabilities. Additionally, CareSource provides members with resources for COVID-19 support, dental, vision, and hearing benefits, as well as pharmacy services. The company emphasizes easy access to healthcare management through online platforms and a mobile app.

📋 Description

• Perform supervision and support of the Provider Data Integrity (PDI) team • Manage key PDI functions for the Ohio provider panel and ensure accurate provider information in applicable CareSource systems • Process provider additions, terminations, and changes accurately and timely • Supervise, mentor, coach, and train staff • Provide direction and oversight of provider information setup and maintenance processes • Ensure compliance with provider contract documents and state and regulatory standards • Respond to calls and emails from internal and external customers • Coordinate with Provider Relations and Credentialing to complete applications missing components • Monitor PDI work queues to ensure Turn Around Times are met • Monitor file aging, work with staff to close files, meet Service Level Agreements, and report trends to the Manager • Participate in the Operations Management Team and meetings • Assist with performance evaluations, hiring, and disciplinary action decisions • Maintain time sheets for non-exempt employees • Coordinate data entry assignments, problem solving, and project management • Supervise quality review, performance feedback, disciplinary issues, and merit/bonus appraisal review • Create, review, revise, and enforce company and departmental policies and procedures • Provide mentoring, training, and ongoing education regarding optimal performance and Standards of Excellence • Perform other job-related instructions as requested

🎯 Requirements

• Associate’s Degree in business or related field or equivalent years of relevant work experience is required • Minimum of three (3) years provider data or supervisory experience is required • Previous experience in a managed care organization is preferred • Intermediate computer skills • Proficiency in Microsoft Word, Outlook and Excel • Ability to work independently and within a team environment • Training/teaching skills • Attention to detail • Ability to effectively support diverse personalities and work styles • Familiarity of the healthcare field • Knowledge of Medicaid • Critical listening and thinking skills • Strategic management skills • Use of proper grammar • Technical writing skills • Time management skills • Proper phone etiquette • Customer service oriented • Decision making/problem solving skills • Knowledge of medical terminology • Ability to identify and recommend process improvements • No licensure or certification required

🏖️ Benefits

• Bonus tied to company and individual performance • Substantial and comprehensive total rewards package • Employee total well-being support