Director, Provider Data & Analytics

Centene Management Company•Atlanta, GA

2d•Hybrid

About The Position

Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility. This is a hybrid position that requires at least 2 days per week in office. Position Purpose: Oversee all of the reporting and data requirements for the health plan, including but not be limited to such activities as: 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.

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.