Manager, Provider Directory Audit

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

Job summary

Point32Health is seeking a Manager, Provider Data Quality to lead the development and oversight of the provider directory quality audit program, including AI agent oversight. You will guide a team focused on ensuring data accuracy across Medicaid, Medicare and commercial products, while maintaining compliance with applicable regulations.

The role requires strong program leadership, data management expertise, and experience with audit platforms.

Qualifications

• Associates, bachelor’s, or other advanced degree preferred. Equivalent work experience required.
• 5-7 years’ experience in a managed healthcare organization.
• Proven experience in program development and team leadership.
• Knowledge of Excel and other Microsoft programs to track, update and analyze data.
• Strong verbal and written communication skills.

Responsibilities

• Facilitate development and implementation of end-to-end provider data audits to improve directory accuracy.
• Design and implement a comprehensive provider directory and data audit program for continuous quality.
• Establish policies, procedures, and standards for provider data management and audits, including roster reconciliation.
• Ensure compliance with relevant provider directory regulations and standards (Medicaid, Medicare and Commercial).
• Oversee enterprise provider directory & attestation platform vendor oversight and performance.

Skills

Project management

Team leadership

Excel

Data management

Verbal & written communication

Education

Bachelor's degree in Business Administration/Healthcare Management/Data Management

Master’s degree preferred

Tools

Attestation platform

Job description

Who We ArePoint32Health is a leading not-for-profit health and well-being organization dedicated to delivering high-quality, affordable healthcare. Serving nearly 2 million members, Point32Health 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 had 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.We enjoy the important work we do every day in service to our members, partners, colleagues and communities. Learn more about who we are at Point32Health.Job SummaryThe Manager, Provider Data Quality, is responsible for the development and successful oversight of the Point32Health provider directory quality audit program, including the oversight of the AI Agent for Directory Audit. This role will be crucial in maintaining the quality and reliability of our provider data, which is essential for our operations and service delivery including the accuracy of the health plan provider directory. The incumbent will lead a team who will be responsible for the directory audit functions, as well as oversight of the attestation vendor platform performance. This role will require subject matter expertise in providing directory regulations for Medicaid, Medicare, and Commercial products.Job DescriptionDUTIES/RESPONSIBILITIES – what you will be doing (top five):Facilitate the development, implementation, of an end-to-end process supporting provider data audits to increase the accuracy of the Point32Health provider directories.Design and implement a comprehensive provider directory and data audit program for continuous improvement of provider directory quality.Establish policies, procedures, and standards for provider data management and audits, and roster reconciliation t.Ensure compliance and stay informed about all relevant regulations and standards related to provider directories.Responsible for the enterprise provider directory & attestation platform vendor oversight and performanceEstablish key performance indicators (KPIs) and metrics to measure the effectiveness of the provider directory and data audit program.Perform other duties as assigned by management.QUALIFICATIONS – what you need to perform the job.EDUCATION, CERTIFICATION AND LICENSURE:Associates, bachelor’s, or other advanced degree preferred. Equivalent work experience required.EXPERIENCE (minimum years required):5-7 years’ experience in a managed healthcare organizationProven experience in program development and team leadership.Knowledge of Excel and other Microsoft programs to track, update and analyze data.Strong verbal and written communication skills.Must be able to work in a high volume, fast paced, goal-orientated environment with quality.Proven ability to function independently.SKILL REQUIREMENTS:Bachelor’s degree in business administration, Healthcare Management, Data Management, or a related field. Master’s degree preferred.Must possess strong verbal and written communication skillsAdvanced understanding and experience with Excel is highly preferredSalary Range$104,612.00 -$156,918.00Compensation & Total Rewards OverviewThe annual base salary range provided for this position represents a range of salaries for this role and similar roles across the organization. The actual salary for this position will be determined by several factors, including the scope and complexity of the role; the skills, education, training, credentials, and experience of the candidate; as well as internal equity. As part of our comprehensive total rewards program, colleagues are also eligible for variable pay. Eligibility for any bonus, commission, benefits, or any other form of compensation and benefits remains in the Company's sole discretion and may be modified at the Company’s sole discretion, consistent with the law.Point32Health offers their Colleagues a competitive and comprehensive total rewards package which currently includes:Medical, dental and vision coverageRetirement plansPaid time offEmployer-paid life and disability insurance with additional buy-up coverage optionsTuition programWell-being benefitsFull suite of benefits to support career development, individual & family health, and financial healthFor more details on our total rewards programs, visit https://www.point32health.org/careers/benefits/We welcome allAll 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.Scam Alert: Point32Health has recently become aware of job posting scams where unauthorized individuals posing as Point32Health recruiters have placed job advertisements and reached out to potential candidates. These advertisements or individuals may ask the applicant to make a payment. Point32Health would never ask an applicant to make a payment related to a job application or job offer, or to pay for workplace equipment. If you have any concerns about the legitimacy of a job posting or recruiting contact, you may contact [e-mail]