Provider Data Manager

CareOregon•Washington, DC

9d•Remote

About The Position

The provider data manager is responsible for overseeing the strategic management and optimization of contracted & non-contracted provider network data within the Network Operations Division. This role ensures comprehensive data collection, quality assurance of provider data, quality improvement initiatives focused on improved data accuracy, and alignment with state and federal requirements. The provider data manager is a people leader who is responsible for management of day-to-day operations of the team, including performance and productivity management. Key CareOregon stakeholders of this role include but are not limited to the following: Provider Engagement; Credentialing; Operations; Clinical leadership; Compliance; Information Systems & Business Intelligence; and Regulatory Affairs. Estimated Hiring Range: $100,350.00 - $122,650.00 Bonus Target: Bonus - SIP Target, 5% Annual Current CareOregon Employees: Please use the internal Workday site to submit an application for this job.

Requirements

Minimum 5 years’ experience in healthcare
Minimum 2 years’ experience in managed care; experience should demonstrate all or most of the following:
Leading teams and complex projects, including developing and mentoring staff
Managing vendors, contracts, and external relationships
Developing policy and strategy roadmaps with business groups and aligning work efforts and solutions accordingly
Excellent knowledge of relational databases and database construction
Knowledge of claims processing workflows and processes
Knowledge of provider healthcare environment
Ability to develop strong working relationships with management and external resources; strong knowledge of cross team calibration
Understands the provider data ecosystem, including how provider data are managed within clinical settings
Ability to develop, implement, monitor, and enforce policy and strategy
Ability to propose solutions and communicate business value
Ability to exercise high degree of professionalism
Ability to influence others
Ability to effectively collaborate with coworkers, staff, leaders, and executives across all departments
Able to see big picture beyond a request and take appropriate holistic action, employing “systems thinking”
Strong analytical and research skills; ability to see patterns in data and draw appropriate conclusions
Ability to maintain a positive attitude
Excellent understanding of managed care, Medicare, and Oregon Health Plan concepts, including the ability to train and coach others on this information
Ability to interpret contract language
Advanced skills in claims processing technologies, such as QNXT and Facets
Advanced skills in document management and collaboration platforms, such as SharePoint
Advanced skills with Microsoft Office Suite products, including Access, PowerPoint, Excel, Word, and Outlook
Comprehension of computer programming concepts and practices
Advanced skills in troubleshooting data integrity issues and root cause
Strong understanding and application of managerial concepts and techniques in areas such as project/ change management, idea creation, employee development, coaching, and cross-team effectiveness
Understanding and adherence to governance and process
Leadership skills in fostering continuous learning, process improvement, empowerment, involvement, and opportunities
Ability to establish an independent view, effectively collaborate in decision-making, and motivate others, especially during difficult situations or on tough organizational issues
Strong verbal and written communication skills, including meeting facilitation and presentations
Ability to effectively communicate complex and/or controversial topics and concepts to a wide and diverse audience
Ability to effectively elevate strategic concerns to senior management in a timely and accurate manner
Ability to work effectively with diverse individuals and groups
Ability to learn, focus, understand, and evaluate information and determine appropriate actions
Ability to accept direction and feedback, as well as tolerate and manage stress
Ability to see, read, and perform repetitive finger and wrist movement for at least 6 hours/day
Ability to hear and speak clearly for at least 3-6 hours/day

Nice To Haves

Minimum 2 years’ experience in a supervisory position or minimum 1 year experience in a supervisory position with completion of CareOregon’s Aspiring Leaders Program
Project management skills preferred
Vendor management skills preferred
Budget management skills preferred

Responsibilities

Responsible for accurate and timely provider network data within the claims processing system, including contract status, specialties, locations, and credentialing information.
Ensure upstream and downstream data acquisition is aligned with system configuration and can be operationalized for accurate claims payment and directory presentation.
Analyze provider data to identify trends, gaps, and opportunities for improvement.
Facilitate quality improvement projects designed to enhance provider data collection and storage.
Ensure that all provider data programs are in compliance with applicable healthcare regulations, including the Oregon Health Authority and the Centers for Medicare & Medicaid Services.
Develop and participate in business planning, budgeting, and operational performance target management.
Manage cross-functional projects related to provider network data, ensuring that project goals, timelines, and budgets are met.
Develop and oversee policies and procedures, incorporating best practices and ensuring consistency.
Monitor and track team metrics through the creation of monthly quality and productivity reports.
Ensure project deliverables are met according to quality control schedules and standards.
Coordinates the compilation and submission of state and federal required provider data reporting such as OHA DSN capacity report, CMS Network Adequacy, HSD table creation, and HEDIS Roadmap.
Develop and monitor key performance indicators for department overall, and department staff.
Align department priorities with enterprise initiatives.
Serve as the Operations product owner for the underlying provider directory data.
Coordinate the provider data team’s communication with external customers regarding provider information, provider status, claims administration as it relates to provider set-up, and responses to changes in the business or regulatory environment.
Represent department in plan governance functions.
Establish and maintain cooperative and productive working relationships with internal and external stakeholders.
Coordinate timely and accurate responses to internal and external (e.g., OHA, HSAG, CMS, KPMG, etc.) audits.
Represent CareOregon in industry workgroups (e.g., QUsers Group Provider Data Workgroup).
Conduct product and vendor research and presents recommendations to team and management.
Manage vendors, including ongoing business reviews and performance management.
Represent CareOregon at the All Plan System Tech meeting.
Manage teams and recommend team direction and goals in alignment with the organizational mission, vision, and values.
Identify work and staffing needs to meet work expectations; recruits and hires, using an equity, diversity, and inclusion lens.
Plan, organize, schedule, and monitor work; ensure employees have information and resources to meet job expectations.
Lead the development, communication, and oversight of team and individual goals; ensure goals, expectations, and standards are clearly understood by staff.
Train, supervise, motivate, and coach employees; provide support toward employee development.
Incorporate guidance from CareOregon equity tools into people leadership, planning, operations, evaluation, and decision making.
Ensure team adheres to department and organizational standards, policies, and procedures.
Evaluate employee performance and provide regular feedback to support success; recognize strong performance and address performance gaps and accountability (corrective action).
Perform supervisory tasks in collaboration with Human Resources as needed.

Benefits

We offer a strong Total Rewards Program. This includes competitive pay, bonus opportunity, and a comprehensive benefits package.
Eligibility for bonuses and benefits is dependent on factors such as the position type and the number of scheduled weekly hours.
Benefits-eligible employees qualify for benefits beginning on the first of the month on or after their start date.
CareOregon offers medical, dental, vision, life, AD&D, and disability insurance, as well as health savings account, flexible spending account(s), lifestyle spending account, employee assistance program, wellness program, discounts, and multiple supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, 529 College Savings, etc.).
We also offer a strong retirement plan with employer contributions.
Benefits-eligible employees accrue PTO and Paid State Sick Time based on hours worked/scheduled hours and the primary work state.
Employees may also receive paid holidays, volunteer time, jury duty, bereavement leave, and more, depending on eligibility.
Non-benefits eligible employees can enjoy 401(k) contributions, Paid State Sick Time, wellness and employee assistance program benefits, and other perks.

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