Senior Director, Provider Network Operations

PacificSource; Virginia; Hybrid; USD 108,000 - 184,000; Full time

Job summary

PacificSource in Virginia is seeking a senior leader to oversee the Provider Network department's core operations, data, and systems functions. You will guide cross-functional planning to align with enterprise goals and ensure performance across Medicaid, Medicare, and Commercial lines.

You will manage Provider Relations, Credentialing, and Provider Data Management, mentor multi-level teams, and drive improvements in data integrity, contract execution, and provider education while maintaining

Qualifications

• 8+ years in a leadership role overseeing healthcare provider network operations.
• Experience leading Provider Relations, Credentialing, or Provider Data Management.
• Ability to develop and execute strategy within a matrixed organization.
• Knowledge of provider reimbursement methodologies and healthcare data management.

Responsibilities

• Guide strategic initiatives for the Provider Network Operations division and related areas.
• Oversee network setup, data integrity, provider education and service, contract implementation, and provider-related claims and audits.
• Ensure privacy and HIPAA compliance in daily operations and processes.
• Lead cross-department planning and execution to meet department and company KPIs.
• Manage large, multi-level teams and drive performance improvements.

Skills

Accountable leadership

Business & financial acumen

Empowerment

Influential Communications

Situational Leadership

Strategic Planning

Education

Bachelor’s degree in business, health care administration, finance, or related field

Job description

PacificSource in Virginia is seeking a senior leader to oversee the Provider Network department's core operations, data, and systems functions. You will guide cross-functional planning to align with enterprise goals and ensure performance across Medicaid, Medicare, and Commercial lines.

You will manage Provider Relations, Credentialing, and Provider Data Management, mentor multi-level teams, and drive improvements in data integrity, contract execution, and provider education while maintaining