Senior Director, Provider Network & Data Operations

MetroPlus; New York (NY); On-site; USD 150,000 - 220,000; Full time

Job summary

MetroPlusHealth in New York is seeking a Senior Director of Provider Network Operations to oversee the performance and experience of the provider network. You will lead data management, directory accuracy, regulatory compliance, and provider communications, driving high-quality partnerships and optimal access for members.

You will guide a team, define strategies to improve reimbursement, directory reliability, and patient experiences while collaborating with senior leadership on regulatory

Qualifications

• Data management, data analytics, quality assurance, and project management skills required.
• Working knowledge of Medicare and Medicaid required.
• Ability to standardize and reconcile disparate data effectively.

Responsibilities

• Oversee Provider Data Management strategy and provider directory accuracy.
• Improve provider experience by collecting feedback and acting on improvements.
• Ensure quick resolution of issues related to reimbursement, directory information, and patient experience.
• Identify efficiency improvements and recommend automated solutions.
• Use network performance data to boost financials, quality, risk adjustment, and growth.
• Collaborate with Senior Leadership and committees on strategic goals.
• Monitor network adequacy to meet regulatory guidelines.
• Ensure regulatory compliance of access and availability standards and vendor oversight.
• Lead provider data accuracy initiatives and discrepancy resolution.
• Review reimbursement trends and reduce claims discrepancies.
• Partner with other functions on strategic planning and acquisitions.
• Manage and develop the team with a culture of accountability.

Skills

Integrity & Trust

Customer Focus

Functional/Technical Skills

Leadership

Communication Skills

Education

Bachelor’s degree in business or healthcare

Master’s degree preferred

Job description

MetroPlusHealth in New York is seeking a Senior Director of Provider Network Operations to oversee the performance and experience of the provider network. You will lead data management, directory accuracy, regulatory compliance, and provider communications, driving high-quality partnerships and optimal access for members.

You will guide a team, define strategies to improve reimbursement, directory reliability, and patient experiences while collaborating with senior leadership on regulatory