Supervisor Provider Data Quality Management

Highmark Health

8d • Onsite

About The Position

This job manages a team of provider file representatives who are responsible for the system implementation of all provider contracts and provider demographics. Oversees an internal audit quality review program designed to ensure provider data accuracy and completeness, and to provide staff with feedback on their quality scores. Provides weekly management reports on quality, work-in-progress, volume trends and training opportunities. Responsible for training, updating departmental procedures, and ensuring consistent processes throughout the department.

Requirements

• Minimum High school diploma or GED
• 1 year of experience working with providers in areas such as enrollment and maintenance
• 1-2 years of experience with staff oversight and/or development, either in a formal or informal capacity
• Demonstrated behavior showing the ability to manage the work of others in a volume-driven environment
• Demonstrated work experience exhibiting strong business, analytical, judgment, and communication skills in a corporate environment
• Knowledge of claims and various provider contracting methodologies
• Understanding of software applications used Highmark Wholecare®, such as Managed Health Care System, CACTUS, OnBase Document Management and/or OnBase Workflow
• Ability to communicate effectively in oral and written form to a wide range of audiences representing a broad cross-section of intellectual abilities and interests

Nice To Haves

• 1 year of experience performing Medicaid and /or Medicare systems setup of provider contracts and provider demographics
• 3 years of experience in a provider data maintenance department of a managed care organization
• Inventory management of production work load
• Direct supervisory and/or management of staff (monitor day to day workloads, disciplinary reviews)
• Project management

Responsibilities

• Supervise non-exempt employees.
• Oversee internal audit/quality review program.
• Maintain and enforce departmental policies and procedures.
• Train staff.
• Meet internal and regulatory standards for timely data entry and report submissions and filings.
• Inventory Management
• Other duties as assigned or requested.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Education Level: High school or GED