Manager, Provider Configuration
Molina Healthcare•Long Beach, CA
About The Position
Leads and manages a team responsible for provider data management (PDM) activities. This includes analyzing business processes related to PDM, identifying areas for improvement, and developing and implementing solutions to optimize performance. The role ensures accurate and timely maintenance of critical provider information for all claims/provider databases, and the application of business rules related to contracting, network management, and credentialing.
Requirements
- At least 7 years of experience in provider data management (PDM), including business analytics experience in health care, or equivalent combination of relevant education and experience.
- At least 1 year management/leadership experience.
- Advanced proficiency in data analysis tools and techniques.
- Strong presentation and interpersonal skills, and ability to interact effectively with stakeholders at all levels.
- Strong critical-thinking skills, and attention to detail.
- Strong organizational and time-management skills; ability to manage simultaneous projects and tasks to meet internal deadlines.
- Strong verbal and written communication skills.
- Microsoft Office suite (including advanced Excel) and applicable software program(s) proficiency.
Responsibilities
- Establishes and maintains internal standard operating procedures (SOPs), and enterprise-wide policies and procedures pertaining to provider functions, ensuring alignment with business objectives.
- Collaborates cross-functionally with departments on issues related to provider data management (PDM), including but not limited to: configuration, business systems, encounters (inbound and outbound), claims, provider services, and contracting.
- Assists in the design and development of new programs related to transitions and implementations of existing plans with regards to provider data.
- Responds to legislative and regulatory developments and audits as they relate to provider information; collaborates cross-functionally to interface with regulators to develop and implement appropriate corrective action plans (CAPs) for submission of provider network files, etc.
- Demonstrates expertise in the handling and management of complaints and other escalated issues from internal customers.
Benefits
- Competitive benefits and compensation package
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What This Job Offers
Job Type
Full-time
Career Level
Manager
Education Level
No Education Listed
