Network Management Manager Provider Data Maintenance

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

Job summary

A leading company in the healthcare sector is seeking a Network Management Manager. This role involves overseeing provider data maintenance, collaborating with multiple departments, and ensuring data integrity in critical systems. The ideal candidate will have substantial experience in managed care and data management, focusing on quality and compliance.

Qualifications

• Minimum 10 years in Managed Care, specifically with Medicare and Medicaid.
• A minimum of 3 years managing teams.
• Must demonstrate excellent communication and multitasking skills.

Responsibilities

• Oversee and manage the Data Maintenance Team performance.
• Ensure data integrity and adherence to business rules.
• Collaborate with various departments to support network operations.

Skills

Data analytics

Analytical skills

Problem-solving

Communication

Tools

SQL

Salesforce

MS Excel

MS Word

MS Access

Job description

Job DescriptionJob 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 be required to oversee and manage the Data Maintenance Team performance, coordinating and managing all aspects of critical provider information on all claims and provider databases. This includes synchronizing data among multiple systems and applications, ensuring business rules are set and enforced. Collaborate with all needed parties to ensure adherence to business and system requirements of customers as it pertains to contracting, network management and credentialing. Manages the development, implementation, and maintenance of provider data in the provider data system. The Network Management Provider Data Maintenance Manager interfaces with the Provider Contracting Department, Provider Network Operations Department, Credentialing Department, Claims Department, Provider Relations Team, and other ancillary departments (e.g., Claims) to develop data integrity to support effective network operations and strategies for provide data maintenance under the direction of the Director of Network Ops. Organizational expert in responding to regulatory reporting around provider data. Engages IT and other departments to implement changes to business rules with the support of the Network Ops Director. The Manager will be responsible for Provider Maintenance special projects, reviewing contracts, letters of agreement and amendments for implementation, in addition to creating, or updating provider and(or) vendor records, and working closely to assist Provider Network Operations staff on provider data related issues and strategies. The Network Provider Data Maintenance Manager must have experience in data analytics , experience with Cognizant and Health Cloud.

Essential Job Functions:

• Creation and maintenance of all provider records within the health plan system(s) includes:
• Leader in demographic data migration to V12/Salesforce
• Participates in all implementation aspects and directs team on all responsibilities for success
• Leader in demographic interface for claims adjudication and payment w/vendor (ILS/Cognizant)
• Manages in partnership with finance the EFT set up /process ; ensuring EFT info is set up and shared with
• Manages and oversees Data Team roles and
• Manage the daily data migration from delegated rosters to the provider platform, V12.
• Setup of demographic and specialty information, panel, line of business and schedules
• Performs data entry accurately and
• Audit current provider contracts and data to ensure they are up to date.
• Act as subject matter expert for other departments as it relates to provider contracts and
• Trouble shoot and identify root cause of problems and collaborate with other departments to resolve provider data
• Identifies and documents opportunities for provider education and communicates to network
• Participates in standing meetings as necessary, including but not limited to provider relations, contracting, network development, team building, network
• Work to create most effective provider maintenance reports and ensure they are assigned the correct
• Prepares correspondence to providers concerning their provider data issues and requests for more

Provider Data Coordination

• Manage new contracts, amendments, LOAs implementation to support organization and
• Work with Provider Contracting Department, Provider Network Operations, Credentialing Department, Claims Department, and/or other ancillary department or vendors to resolve contract configuration discrepancies in a timely
• Assign standard and new custom templates to respective provider records.
• Assist in resolving escalated provider issues from Senior Management
• Receive, coordinate, and manage requests submitted to/from IT Department, Claims Department, or other
• Communicate with cross departmental representatives to address provider data
• Assist in the implementation of changes to the provider file and corresponding
• Conduct/coordinate testing of all Contract/Provider changes and verify results prior to a move to
• Communicate with providers and vendors to secure supporting documents for creating and maintaining
• Develop and document processes and

Provider Data Analysis

• Receives and reviews provider network updates to support changes to network
• Analyze, organize, and maintain records to ensure the most updated provider data is
• Summarizes and report findings to ensure follow-up action items are resolved
• Determine gaps in provider data and develop reporting and solutions to rectify provider data issues

Qualifications & Minimum Requirements

• This position requires a minimum of 10 years' progressive experience in Managed Care, specifically Medicare and Medicaid working closely with provider network
• This position requires a minimum of 3 years' experience managing
• Experience in Sales Force, SQL proficiency, Proficiency with MS applications, including but not limited to Word, Excel, Access and
• Analytical and problem-solving skills including ability to multitask with a strong focus on follow through and attention to detail.
• Ability to adapt to changes in a fast-moving
• Must be able to work independently and as part of a team to complete assigned
• Excellent communication skills both oral and written

VillageCare is an Equal Opportunity Employer.

Job Posted by ApplicantPro