Director

Sagility; Bengaluru Urban; On-site; INR 8,646,000 - 12,488,000; Full time

Job summary

Sagility invites an experienced Provider Data Management Specialist to support operations and drive new solutions for the PDM line of business. You will ensure data integrity, regulatory compliance, and efficient provider data processes for health plan customers, collaborating with IT, CRM, and operations to improve data quality and outcomes.

Ideal candidates bring deep PDM knowledge, credentialing experience, and the ability to lead cross-functional initiatives while maintaining high standards

Qualifications

• Bachelor's degree in healthcare administration, business, or related field; master's preferred.
• 10+ years in Provider Data Management or related field with US healthcare exposure.
• Experience in provider credentialing, data validation, and regulatory compliance.

Responsibilities

• Manage provider data management projects, including system enhancements and data migrations.
• Oversee provider credentialing and enrollment processes with verification of licenses and certifications.
• Collaborate with IT, operations, and sales to ensure usable data management systems.
• Design reports on provider data metrics and trends for management and stakeholders.
• Develop data governance policies and monitor data quality across the organization.

Skills

PDM domain expertise

Data governance

Regulatory compliance

Stakeholder management

Data analysis

Leadership

Microsoft Office

Education

Bachelor's in healthcare administration

Master's degree preferred

Tools

PDM software

MS Office

Data analysis tools

Job description

The U.S. Healthcare Provider Data Management Specialist is an individual contributor role responsible for supporting Operations and participating in building new solutions and services for Provider Data Management line of business. This position involves deep subject matter expertise in Provider Data Management and Credentialing operations, identifying, and implementing cost-saving measures, having experience and exposure to transformational projects relating to Provider Data Management. The Provider Data Management Specialist will ensure data integrity, compliance with regulatory requirements, and efficient processes for provider data management for health plan customers.

Duties and responsibilities

• Exceptional in PDM domain and understands the delivery and solutions landscape in PDM domain.
• A self-motivating leader who can ideate, implement, help develop and execute innovative strategies for healthcare Provider Data Management operations to achieve business objectives and improve overall efficiency and effectiveness.
• Stay informed about industry trends, advancements in provider data management technologies, and best practices. Continuously seek opportunities for process improvement and implement changes accordingly.

Provider Data Management

• Manage projects related to provider data management, including system enhancements, process improvements, and data migration initiatives.
• Manage provider credentialing and enrollment processes, including verification of licenses, certifications, and accreditations.
• Collaborate with IT teams to ensure optimal functionality and usability of provider data management systems and software.
• Design reports and presentations on provider data metrics, trends, and performance indicators for management and stakeholders.

Data Governance

• Develop and implement data governance strategies and policies to ensure consistent and standardized management of provider data across the organization. Establish data quality metrics and monitor data accuracy and completeness.

Stakeholder Management

• Collaborate with internal stakeholders, including contracting, network management, claims, and other departments, to ensure accurate provider data for operational and reporting needs. Address and resolve provider data-related issues and inquiries.
• Proficient in collaborating and working through multiple internal functions (Technology, CRM, Operations and Sales). Take responsibility for driving transformational projects and for cross-selling new services to clients.

Compliance and Regulatory Adherence

• Ensure compliance with federal, state, and local regulations related to healthcare PDM, including but not limited to HIPAA,HIPAA, HITECH Act, NSA, and ACA .
• Develop and maintain policies and procedures that promote adherence to regulatory requirements, conducting regular audits and assessments to identify and address compliance gaps.
• Keep up to date with changes in healthcare regulations and PDM policies, providing guidance and training to staff members to ensure awareness and compliance.

Performance Reporting & Continuous Improvements

• Develop and maintain performance metrics and key performance indicators (KPIs) for provider data management operations. Prepare and present regular reports on data accuracy, timeliness, and process efficiency to management.
• Stay informed about industry trends, advancements in provider data management technologies, and best practices. Continuously seek opportunities for process improvement and implement changes accordingly
• Excellent collaboration and influencing skills and ability to work in a metricized organization.
• Strong leadership and managerial skills with a proven track record of successfully leading and developing high-performing teams.
• Excellent analytical, problem-solving, and decision-making abilities.
• Exceptional communication and interpersonal skills, with the ability to collaborate effectively with internal and external stakeholders.
• Strong understanding of compliance requirements and experience in ensuring adherence to regulations.
• Proficiency in using PDM software, data analysis tools, and Microsoft Office Suite.

Minimum education and experience required

• Bachelor's degree in healthcare administration, business administration, or a related field. A master's degree is preferred.
• An overall U.S healthcare experience between 18+ years with extensive operational experience (typically 10+ years in PDM) Provider Data Management or a related field.
• In-depth knowledge of Provider recruitment, provider data setup and management, data validation and credentialing/re-credentialing processes for health plans.
• Understanding of provider outreach operations for validating provider data.

Understanding of provider credentialing and enrollment processes, including verification of professional licenses, certifications, and accreditations, to ensure compliance with regulatory requirements.