Team Lead, Provider Data Integrity (SQL/Provider Data Experience)

CareSource; United States; On-site; USD 63,000 - 100,000; Full time

Job summary

CareSource is seeking a Team Lead, Provider Data Integrity to supervise the PDI team and ensure accurate provider information across CareSource systems. The role partners with Provider Relations and Credentialing to complete applications and maintains SLA performance.

The ideal candidate has at least 3 years of provider data or supervisory experience, a business-related associate degree, and strong Excel/Word skills to drive data quality and regulatory compliance.

Qualifications

• Associate degree required.
• Minimum of 3 years provider data or supervisory experience.
• Experience in a managed care organization preferred.

Responsibilities

• Supervise and support the Provider Data Integrity (PDI) team.
• Manage key PDI functions to meet regulatory and operational responsibilities for the Ohio provider panel.
• Ensure accurate provider information in CareSource systems.
• Oversee accurate processing of provider additions, terminations, and changes.
• Mentor staff and provide training.
• Coordinate data entry activities and monitor service levels.

Skills

Microsoft Word

Microsoft Excel

Microsoft Outlook

Communication skills

Independent work

Time management

Attention to detail

Customer service

Problem solving

Medical terminology

Education

Associate degree in business or related field

Tools

Microsoft Word

Microsoft Excel

Microsoft Outlook

Job description

Job Summary

The Team Lead, Provider Data Integrity performs supervision and support of the Provider Data Integrity (PDI) team.

Job Summary

The Team Lead, Provider Data Integrity performs supervision and support of the Provider Data Integrity (PDI) team.

Essential Functions

• Perform supervision and support of the Provider Data Integrity (PDI) team
• Manage key PDI functions to meet regulatory and operational responsibilities for the Ohio provider panel, and ensure accurate provider information in applicable CareSource systems
• Responsible for accurate and timely processing of provider additions, terminations, and changes to meet regulatory requirements and maintain provider panel information for CareSource products
• Supervise, mentor, and coach staff, and ensure appropriate staff training
• Provide direction and oversight of business processes to ensure accurate setup and maintenance of defined provider information in applicable systems, and ensure compliance with provider contract documents
• Assure that data entry activities are accurate, timely, and compliant with state and regulatory standards
• Respond to calls and emails from internal/external customers
• Coordinate efforts with Provider Relations (PR) and Credentialing to complete all applications missing components
• Continuously monitor all PDI work queues to ensure Turn Around Times (TAT) are being met
• Weekly monitoring of aging of files and working with PDI staff to close in order to meet Service Level Agreements and report to Manager any trends or patterns
• Actively participate in the Operations Management Team and meetings
• Assist with performance evaluations, hiring, and disciplinary action decisions
• Maintain time sheets for non-exempt employees
• Coordinate data entry activities related to assignments, problem solving, and project management
• Supervise staff for quality review, performance feedback, disciplinary issues, and merit/bonus appraisal review
• Create, review, revise, and enforce company and departmental policies and procedures
• Provide mentoring, training, and ongoing education in regards to optimal performance and Standards of Excellence
• Perform any other job related instructions, as requested
  

Education And Experience

• Associate’s Degree in business or related field or equivalent years of relevant work experience is required
• Minimum of three (3) years provider data or supervisory experience is required
• Previous experience in a managed care organization is preferred
  

Competencies, Knowledge And Skills

• Intermediate computer skills
• Proficiency in Microsoft Word, Outlook and Excel
• Communication skills
• Ability to work independently and within a team environment
• Training/teaching skills
• Attention to detailAbility to effectively support diverse personalities and work styles
• Familiarity of the healthcare field
• Knowledge of Medicaid
• Critical listening and thinking skills
• Strategic management skills
• Use of proper grammar
• Technical writing skills
• Time management skills
• Proper phone etiquette
• Customer service oriented
• Decision making/problem solving skills
• Knowledge of medical terminology
• Ability to identify and recommend process improvements
  

Licensure And Certification

• None
  

Working Conditions

• General office environment; may be required to sit or stand for extended periods of time
  

Salary

$62,700.00 - $100,400.00 CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Organization Level Competencies

• - Fostering a Collaborative Workplace Culture
• - Cultivate Partnerships
• - Develop Self and Others
• - Drive Execution
• - Influence Others
• - Pursue Personal Excellence
• - Understand the Business

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.