Healthcare Payer Ops Leader: Provider Data & Process

Programmers.io; East Brunswick Township (NJ); Presencial; USD 180.000 - 240.000; Jornada completa

Descripción de la vacante

Programmers.io is seeking a Senior Healthcare Payer SME / Strategic Program Leader with deep expertise in Provider Data Management, Provider Lifecycle Operations, and AI-driven transformation initiatives.

The role focuses on end-to-end provider data lifecycle, onboarding and contracting, credentialing and recredentialing, and governance across payer operations. Strong stakeholder management and large-provider experience are essential.

Formación

• 15+ years of healthcare payer experience.

Responsabilidades

• Serve as SME for end-to-end provider data lifecycle management.
• Define and improve provider data processes including setup, maintenance, and directory management.
• Ensure provider data accuracy across demographics, specialties, affiliations, and networks.
• Support governance, quality controls, audits, and regulatory compliance initiatives.
• Lead provider onboarding from contracting through production readiness and coordinate with network, contracting, credentialing, and operations teams.
• Analyze onboarding bottlenecks and drive process improvements.
• Provide expertise in credentialing workflows and PSV, sanction monitoring, and enrollment.

Conocimientos

Payer domain expertise

Provider Data Management

Onboarding & contracting

Credentialing & recredentialing

Regulatory compliance

Stakeholder management

Educación

Bachelor's degree in Healthcare Administration or related field

Herramientas

Facets Provider Module

NICE

NDB

Salesforce

Descripción del empleo

Programmers.io is seeking a Senior Healthcare Payer SME / Strategic Program Leader with deep expertise in Provider Data Management, Provider Lifecycle Operations, and AI-driven transformation initiatives.

The role focuses on end-to-end provider data lifecycle, onboarding and contracting, credentialing and recredentialing, and governance across payer operations. Strong stakeholder management and large-provider experience are essential.