Sr Director, Provider Data Management

SCAN Health Insurance•Long Beach, CA

8d•$177,500 - $244,648•Remote

About The Position

The Sr. Director, Provider Data Management will supervise and direct the loading and timely maintenance of provider data within the core systems. Works in partnership with internal and external stakeholders, as well as vendors, to ensure the precision of provider data in provider directories and internal systems. Assumes the responsibility of designing the provider data framework to align with the company's expansion and growth initiatives. Ensures adherence to all compliance and regulatory requirements concerning provider data and maintains adherence to SLAs.

Requirements

Bachelor’s Degree or 7+ years of equivalent experience
5+ years of leadership experience
4+ years in leading Provider Data Management teams at managed care provider organization (IPA, Medical Group or institutional provider) or insurance company.
7 + years of overall Healthcare experience.
Ability to foster teamwork.
Leadership skills.
Ability to drive strategic direction.
Oral and written communication skills.
Ability to build collaborative relationships.
Analytical thinking skills.
Technical expertise.
Detail oriented.
Project management skills.
Complete understanding for CMS and DHCS requirements for provider data maintenance and directories is required.
Familiar with a variety of the Medicare and Medicaid's concepts, practices, and procedures.
Strong interpersonal skills, including excellent written and verbal communication skills.
Strong organizational skills.
Consistently demonstrates self-motivation, integrity, initiative and innovation in achieving results.
Strong communication (written and verbal), influencing, negotiating, listening and interpersonal skills to effectively develop productive internal and external relationships.
Strong presentation skills to effectively address diverse audiences.
Ability to multitask.
Ability to appropriately maintain confidentiality.
Project management skills and supervisory experience.

Nice To Haves

We seek Rebels who are curious about AI and its power to transform how we operate and serve our members.

Responsibilities

Establishes policies and procedures governing the collection, storage, and retrieval of multiple data types taken from disparate sources.
Develops quality standards and validation processes to ensure accuracy and integrity of organizational data based on guidelines set by project stakeholders or requirements of downstream systems.
Oversee all provider data accuracy verification process including quarterly verifications and adopt to new business rules as required by business needs.
Audit delegated medical groups providers data periodically and asses and report any risks with their data.
Oversee implementation and maintenance of vendor applications for provider data maintenance and accuracy verifications.
Supports key operational strategic initiatives with a focus on systems and processes.
The Director, Provider Data Management will ensure that vendors comply with the Key Performance Indicators (KPIs) established for provider data quality by consistently monitoring and verifying their adherence to these standards.
Acts as a liaison between the end-user of the data and the data storage/management architecture team to ensure that functional requirements are technologically feasible and resulting systems meet user needs.
Leads and directs the work of other employees and has responsibility for personnel actions including hiring, performance management, and termination. Supervision is often provided through a team of subordinate managers.
Contributes to strategic planning, direction, and goal setting for the department or function in collaboration with senior management.
Establishes departmental policies, practices, and procedures that have a significant impact on the organization.
Provide leadership and guidance to the team in order to generate innovative process improvements that effectively address emerging business challenges. Additionally, offer mentorship to team members to facilitate their professional development and enhance their problem-solving capabilities.
Maintains a formal process for proactively determining and ensuring the SCAN provider network meets CMS and state requirements.
Understand and implement new and future compliance requirements.
Direct small, medium and large projects and initiatives.
Partner with cross functional teams to define and deliver solutions according to agreed-upon business requirements and timelines.
Ensures the maintenance of organizational, departmental, federal, and state-specific standards, while also achieving and sustaining accuracy in overall provider processing.
Responsible for architecting the provider hierarchies to meet the business growth and expansion needs.
Accomplish staff results by communicating job expectations; planning, monitoring, and appraising job results; coaching and counseling employees; initiating, coordinating, and enforcing systems, policies, and procedures.
Motivates and maintains staff by recruiting, selecting, orienting, and training employees; maintaining a safe and secure work environment; developing personal growth opportunities.
Proactively identify opportunities for process improvements. Make recommendations to appropriate stakeholders and actively manage through project delivery.
Build strong collaborative relationships with internal and external stake holders and perform at an organizational level.
The Director, Provider Data Management will oversee Provider Data Management and Provider Data quality teams and ensure they meet all SLAs.
Establishes staffing needs and ensures consistent training for staff through adoption of standardized processes.
Supports critical business strategies by providing systematic solutions and or recommendations on business processes.
Proficient in navigating legislative changes, federal and state regulations, to direct teams to make necessary changes.
Oversee the creation of document workflows and policies and procedures (P&Ps) as necessary.
Ensure updates (adds, changes, and terminations) for new or existing provider records are made per Health Plan Service Level Agreements (SLAs).
Responsible for data accuracy on internal and external provider directories.
Actively support the achievement of SCAN’s Vision and Goals.
Other duties as assigned.

Benefits

An annual employee bonus program
Robust Wellness Program
Generous paid-time-off (PTO)
11 paid holidays per year, 1 floating holiday, birthday off, and 2 volunteer days
Excellent 401(k) Retirement Saving Plan with employer match
Robust employee recognition program
Tuition reimbursement
A competitive compensation and benefits program
Eleven paid holidays per year
Excellent Retirement Savings program
A work-life balance