Director, Provider Data & Analytics

Centene Corporation•Atlanta, GA

4d•$113,100 - $209,100•Hybrid

About The Position

Centene is transforming the health of its communities, one person at a time. This is a hybrid position that requires at least 2 days per week in office. The purpose of this role is to oversee all reporting and data requirements for the health plan. This includes encounter reporting development and submission, network development reporting, provider data reporting and data comparisons for start-up and ongoing operations, extractions for directory submissions, maintenance of data among multiple systems for integrity, operational scorecards, and other reporting and data requirements as defined by the plan. The role also oversees the Provider Data Department, including provider set-up forms, maintenance of provider records, auditing provider data records, and managing all coordinator staff. There is direct oversight for the Credentialing function (in partnership with QI) ensuring a seamless process between credentialing and provider data integrity. The role is responsible for creating, validating, and producing reports for state or other reporting needs, supporting and participating in the production of GeoAccess reports and provider network reports required for submission to the state on an ongoing basis. Additionally, the role coordinates with Provider Relations and Claims to address Network Data errors, develops reports to assure data integrity among multiple data sources, and works with accountable departments to resolve issues. The role is responsible for working with the QI department in the development of QI and credentialing reports and is accountable for any ad hoc reporting needs as defined by the health plan.

Requirements

Bachelor's degree in a related area or equivalent experience.
7+ years of experience in a similar position in a health plan or network setting.
Previous management experience including responsibilities for hiring, training, assigning work and managing performance of staff.

Responsibilities

Oversee all of the reporting and data requirements for the health plan, including encounter reporting development and submission, network development reporting, provider data reporting and data comparisons for start up and ongoing operations, extractions for directory submissions, maintenance of data among multiple systems for integrity, operational scorecards, and other reporting and data requirements as defined by the plan.
Oversee Provider Data Department including provider set up forms, maintenance of provider records and audit provider data records as well as management of all coordinator staff.
Direct oversight for Credentialing function (in partnership with QI) ensuring the process between credentialing and provider data integrity is seamless.
Create, validate and produce reports for state or other reporting needs.
Support and participate in production of GeoAccess reports and provider network reports required for submission to the state on an ongoing basis.
Coordinate with Provider Relations and Claims to address Network Data errors.
Develop reports to assure data integrity among multiple data sources and works with accountable departments to resolve issues.
Responsible for working with the QI department in the development of QI and credentialing reports.
Accountable for any ad hoc reporting needs as defined by the health plan.