Network Management Manager Provider Data Maintenance

Village Care; New York (NY); Remote; USD 102,000 - 116,000; Full time

Job summary

A leading company in healthcare management is seeking a Network Management Manager for Provider Data Maintenance. This remote role requires overseeing a data maintenance team, ensuring data integrity, and managing provider data across systems. Candidates should have extensive experience in Managed Care, particularly with Medicare and Medicaid, and strong skills in Salesforce and data analytics.

Qualifications

• Minimum of 10 years' experience in Managed Care, especially Medicare and Medicaid.
• At least 3 years' management experience.
• Proficiency in Salesforce, SQL, and MS Office.

Responsibilities

• Oversee and manage the Data Maintenance Team.
• Ensure data integrity and support regulatory reporting.
• Manage provider maintenance projects and contract reviews.

Skills

Analytical skills

Problem-solving skills

Multitasking skills

Communication skills

Tools

Salesforce

SQL

MS Office

Job description

Position: Network Management Manager Provider Data Maintenance

Location: Remote (Must reside in NY/NJ/CT)

Schedule: Monday - Friday 9am-5pm

Compensation: $102,600 - $115,400 annual salary

Summary:

The Network Provider Data Maintenance Manager will oversee and manage the Data Maintenance Team, coordinating all aspects of critical provider information on claims and provider databases. Responsibilities include data synchronization across systems, enforcing business rules, collaborating with departments on contracting, network management, and credentialing, and managing provider data in the system. The role involves interfacing with multiple departments to ensure data integrity, supporting regulatory reporting, and implementing business rule changes with IT. The Manager will also handle provider maintenance projects, contract reviews, and updates, working closely with Provider Network Operations. Experience with data analytics, Cognizant, and Health Cloud is required.

Essential Job Functions:

1. Creation and maintenance of provider records, including demographic data migration to V12/Salesforce.
2. Participation in implementation projects and team leadership.
3. Management of demographic interfaces for claims adjudication and vendor payments.
4. Overseeing EFT setup in partnership with finance.
5. Managing daily data migration from delegated rosters to V12.
6. Setup of demographic, specialty, panel, and fee schedule information.
7. Performing accurate data entry and audits of provider contracts and data.
8. Serving as subject matter expert on provider contracts and troubleshooting data issues.
9. Communicating with providers regarding data issues and updates.
10. Managing new contracts, amendments, and LOA implementations.
11. Resolving contract discrepancies with various departments and vendors.
12. Leading provider data analysis, reporting, and identifying data gaps.
13. Developing processes for provider data management and reporting.

Qualifications & Minimum Requirements:

• Minimum of 10 years' experience in Managed Care, especially Medicare and Medicaid, with provider network involvement.
• At least 3 years' management experience.
• Proficiency in Salesforce, SQL, MS Office (Word, Excel, Access).
• Strong analytical, problem-solving, and multitasking skills.
• Ability to adapt to fast-changing environments.
• Ability to work independently and collaboratively.
• Excellent oral and written communication skills.

VillageCare is an Equal Opportunity Employer.