Job DescriptionReporting to the VP of Network for MCC, the Sr. Director of Provider Data Management is responsible for leading strategic and operational aspects of Network Provider Data Management for Magellan Complete Care (MCC), including provider demographics, analytics and team leadership. The Sr. Director interfaces with organizational stakeholders on the nature of the network including taxonomy and adequacy. This leader will work with the field on contracts and ensure that provider data is correct while ensuring individual staff productivity and compliance with accreditation, state/federal, and customer requirements. The Sr. Director ensures timely execution of data management and flow of contract, rate and provider data to internal stakeholders and customer claims and clinical systems. He/she acts as the primary subject matter expert during customer and accrediting body audits. The Sr. Director provides leadership to establish a positive work environment that encourages employee participation in process improvement and commitment to organization success.
- Contributes towards the company’s growth and profitability objectives through effective leadership.
- Responsible for all aspects of provider demographic data, including quality, throughput and reporting.
- Serves as subject matter expert in provider demographic data and will also contribute on credentialing, re-credentialing, contracting methodologies, reimbursement methodologies, reimbursement coding, and network configurations and analysis for provider databases to internal, vendor and customer claims systems.
- Develops, implements and manages strategies to simplify processes and decrease administrative costs, including vendor/partner management.
- Supports customer expectations relative to access to care, geo access requirements, provider satisfaction, credentialing timeliness and accreditation, contract commitments and performance guarantees, quality, network development requirements, implementations, etc.
- Collaborates cross functionally to ensure all intersecting functions performed by provider data management favorably impact other operations/services within the organization, i.e. claims, clinical, customer service, etc.
- Submits monthly reports timely, meets projects deadlines, and provides timely follow-up to internal and external customers to ensure expectations are met/exceeded.
- Establishes and meets 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 data administration 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.
- 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.
- 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.
- Provides leadership to drive top performance. Leads hiring and training activities for staff. Ensures timely performance feedback and opportunities for development are provided.
- Establishes standards, policies, procedures and workflows for data entry, accuracy, reporting, database security and data dictionary.
General Job Information
TitleSr. Director, Provider Data Management
Job FamilyOperations Group
FLSA StatusUnited States of America (Exempt)
Recruiting Start Date10/28/2019
Date Requisition Created10/28/2019
Work ExperienceHealthcare, Management/Leadership, Network
EducationBachelors (Required), Masters
License and Certifications - Required
License and Certifications - Preferred
Other Job Requirements
- Understanding of health delivery systems.
- Knowledge of managed health care, health care trends, including reimbursement and coding and network management/ administration.
7+ years Network operations
- 7 or more years’ experience in network operations and/or contracting roles preferably within a large (national/regional) hospital systems and/or health plan.
- Health plan and provider-side experience specifically with direct provider credentialing, and/or contracting experience in a production environment is strongly preferred.
- 5 or more years leadership/management experience required.
7+ years Network Provider Data management experience
7+ years Healthcare experience
7+ years Management/Leadership
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.