VP, Provider Data Management
Job DescriptionDevelops and directs overall strategy for effective completion of all transaction functions and management of provider data across the enterprise. Transactions include, but are not limited to, Contract Management and Execution, Credentialing, Pricing Configuration and Rate/Fee Schedules, Data Entry and Maintenance. Supports the needs of all downstream consumers of provider data such as claims processing, PCP and provider selection, reporting, encounters, electronic funds transfer (EFT)/electronic remittance advice (ERA) and reimbursement processes. Interfaces with organizational stakeholders regarding clinical and/or legal issues impacting, or impacted by provider data. Acts as subject matter expert for operating systems, supporting areas of accountability. Responsible for the development and maintenance of credentialing, contracting and reimbursement policies and procedures. Analyzes, monitors and acts upon trends and performance in the management of credentialing applications, contracts and provider data, individual staff productivity, and compliance with accreditation, state/federal, and customer requirements. Ensures timely execution of data management and flow of contract, rate and provider data to internal stakeholders and customer claims and clinical systems. Acts as primary subject matter expert during client and accrediting body audits. Provides leadership to establish a positive work environment that encourages employee participation in process improvement and commitment to department/company success. Holds budgetary accountability for the department.
- Provides expert consultation in organizational credentialing, re-credentialing, contracting methodologies, reimbursement methodologies, reimbursement coding, and network configurations and analysis for provider databases to internal, vendor and customer claims systems.
- Establishes internal and external department communications and team building.
- Submits monthly reports timely, meets projects deadlines, and provides timely follow-up to internal and external customers.
- Monitors and reports key metrics of department performance for productivity and quality, as appropriate.
- Prepares and oversees departmental budget.
- Establishes productivity (reasonable expectations for performance and turnaround times) and quality standards and tools to measure functional and workflow outcomes for new program implementations with respect to provider activities.
- Maintains and meets productivity and performance standards for all activities for successful program execution.
- Assures the establishment and application of a systematic model for the preparation of network administration, privileging and provider loads.
- Evaluates productivity and performance reports and data for the purposes of reporting, providing employee feedback and determining changes necessary to improve performance.
- Ensures process changes are developed when necessary, training is provided, processes are implemented and results support department success.
- Directs cross-functional projects in conjunction with various departments to develop and implements complex provider related data collection, analysis, data quality, and reporting software and data applications on a variety of information systems platforms.
- Directs database and information systems functions assuring quality of information and efficiency of technology.
- Develops functional specifications, the design of detailed flow charts of systems applications and confers with technical personnel in systems analysis and application planning.
- Directs records management activities for electronic and physical provider files.
- Manages network reporting team, ensuring timeliness and reporting output and maximization of resources and technology.
- Directs hiring and training of department managers, supervisors, and other staff.
- Ensures timely performance feedback and opportunities for development.
- Designs and participates in programs to foster an environment of employee growth and opportunity; manages turnover.
- Prepares annual department budget and manages costs to achieve financial targets.
- Develops and implements strategies to simplify processes and decrease administrative costs.
- Establishes standards, policies, procedures and workflows for data entry, accuracy, reporting, database security and data dictionary.
General Job Information
TitleVP, Provider Data Management
Job FamilyNetwork Services Group (Inactive)
CountryUnited States of America
FLSA StatusUnited States of America (Exempt)
Recruiting Start Date6/17/2019
Date Requisition Created6/17/2019
Work ExperienceHealthcare, Managed Healthcare, Management/Leadership
EducationBachelors: Business Administration (Required), Masters
License and Certifications - Required
License and Certifications - PreferredPMP - Project Management Professional - Enterprise
Other Job Requirements
10 years of progressively responsible health care administration experience with strong preference for managed care experience.
5 or more years experience in a leadership role.
Bachelor's Degree in Business Administration
PMP Certification preferred
Master's Degree preferred
Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, comply and attest to the security responsibilities and security controls unique to their position.