Manager, Provider Directory Audit

Point32Health; Canton (MA); On-site; USD 104,612 - 156,918; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Retirement plans

Paid time off

Employer-paid life and disability

Tuition program

Well-being benefits

Career development opportunities

Job summary

Point32Health is seeking a Manager, Provider Data Quality to lead and advance the provider directory quality audit program, including the AI Agent for Directory Audit. You will drive data accuracy, lead a team, and ensure compliance with Medicaid, Medicare, and Commercial directory regulations.

The role requires 5–7 years in managed healthcare, strong leadership, and expertise in Excel and Microsoft tools to monitor audits and performance metrics.

Qualifications

• Associate’s or bachelor’s degree preferred; equivalent work experience acceptable.
• 5–7 years’ experience in a managed healthcare organization.
• Proficiency with Excel and other Microsoft programs for tracking, updating, and analyzing data.
• Strong verbal and written communication skills.
• Ability to work in a high-volume, fast-paced, goal-oriented environment with quality focus.
• Proven ability to function independently.

Responsibilities

• Facilitate the development, implementation, and continuous improvement of an end‑to‑end process supporting provider data audits.
• Design and implement a comprehensive provider directory and data audit program.
• Establish policies, procedures, and standards for provider data management and audits, including roster reconciliation.
• Ensure compliance with all relevant provider directory regulations and standards.
• Oversee the enterprise provider directory & attestation platform vendor performance.
• Establish key performance indicators and metrics to measure the effectiveness of the provider directory and data audit program.
• Perform other duties as assigned by management.

Skills

Program development

Team leadership

Communication

Independent work

Education

Associate/Bachelor degree

Tools

Excel

Microsoft Office

Job description

Who We Are

Point32Health is a leading not-for-profit health and well‑being organization dedicated to delivering high-quality, affordable healthcare. Serving nearly 2 million members, it builds on the legacy of Harvard Pilgrim Health Care and Tufts Health Plan to provide access to care and empower healthier lives for everyone. Our culture revolves around being a community of care and having shared values that guide our behaviors and decisions. We’ve maintained a long‑standing commitment to inclusion and equal healthcare access and outcomes, regardless of background; it’s at the core of who we are. We value the rich mix of backgrounds, perspectives, and experiences of all of our colleagues, which helps us to provide service with empathy and better understand and meet the needs of the communities where we serve, live, and work.

Job Summary

The Manager, Provider Data Quality will develop and oversee the Point32Health provider directory quality audit program, including the AI Agent for Directory Audit. This role maintains the quality and reliability of our provider data and is essential for accurate health plan provider directories. The incumbent leads a team responsible for directory audit functions, attestation vendor platform performance, and requires expertise in Medicaid, Medicare, and Commercial directory regulations.

Duties / Responsibilities

• Facilitate the development, implementation, and continuous improvement of an end‑to‑end process supporting provider data audits.
• Design and implement a comprehensive provider directory and data audit program.
• Establish policies, procedures, and standards for provider data management and audits, including roster reconciliation.
• Ensure compliance with all relevant provider directory regulations and standards.
• Oversee the enterprise provider directory & attestation platform vendor performance.
• Establish key performance indicators and metrics to measure the effectiveness of the provider directory and data audit program.
• Perform other duties as assigned by management.

Qualifications

Education and Certification

• Associate’s, bachelor’s, or higher degree preferred; equivalent work experience acceptable.

Experience

• 5–7 years’ experience in a managed healthcare organization.
• Proven program development and team leadership experience.
• Proficiency with Excel and other Microsoft programs for tracking, updating, and analyzing data.
• Strong verbal and written communication skills.
• Ability to work in a high‑volume, fast‑paced, goal‑oriented environment with quality focus.
• Proven ability to function independently.

Skill Requirements

• Degree in business administration, healthcare management, data management, or related field; master’s preferred.
• Excellent verbal and written communication skills.
• Advanced understanding and experience with Excel preferred.

Salary Range

$104,612.00 – $156,918.00

Compensation & Total Rewards Overview

The annual base salary range for this position reflects the scope and complexity of the role and the skills, education, training, credentials, and experience of the candidate. Eligibility for variable pay and other benefits is at the Company’s sole discretion in accordance with the law.

• Medical, dental, and vision coverage
• Retirement plans
• Paid time off
• Employer‑paid life and disability insurance with additional buy‑up coverage options
• Tuition program
• Well‑being benefits
• Full suite of benefits to support career development, individual and family health, and financial health

We welcome all

All applicants are welcome and will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.