Executive Lead, Provider Network Operations

PacificSource; Bend (OR); On-site; USD 108,468 - 184,396; Full time

Job summary

PacificSource is seeking a senior operations leader to oversee the Provider Network Operations, including provider data management, credentialing, and interoperability across Medicaid, Medicare, and Commercial lines. You will guide strategic initiatives, collaborate with analytics, and lead education and relationship management efforts with providers.

The role requires deep expertise in provider reimbursement, data governance, and compliance, with a track record of driving cross-functional

Qualifications

• Minimum of 8 years in healthcare operations with management experience.
• Expertise in provider reimbursement methodologies, provider relations, data management, and compliance.
• Experience developing, communicating, and executing strategy in a matrixed organizational structure.

Responsibilities

• Guide strategic initiatives for the Provider Network Operations division, including network setup and maintenance, provider data integrity, provider education and service, contract implementation performance, provider-related claims, provider setup and audits, corrective action plan assessment and closure, and provider directory accuracy improvements.
• Collaborate with the Provider Reimbursement Insights and Analytics Team to ensure objectives are met.
• Develop, direct, and execute efforts to meet Credentialing division objectives, ensuring compliance and operational excellence.
• Develop and execute strategies for provider education and relationship management to enhance provider collaboration, engagement, and satisfaction within the Provider Relations Team.
• Lead initiatives to ensure seamless integration and ongoing operational effectiveness of provider network platforms with legacy and emerging systems.

Skills

Provider reimbursement

Provider relations

Data management

Compliance

Strategy development

Education

Bachelor's degree in business/health care administration/finance

Associate’s degree + 2 years relevant experience

High school diploma + 4 years relevant experience

Job description

PacificSource is seeking a senior operations leader to oversee the Provider Network Operations, including provider data management, credentialing, and interoperability across Medicaid, Medicare, and Commercial lines. You will guide strategic initiatives, collaborate with analytics, and lead education and relationship management efforts with providers.

The role requires deep expertise in provider reimbursement, data governance, and compliance, with a track record of driving cross-functional