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Lead Provider Data Management Specialist

Charlotte, North Carolina Apply Now Job ID 1148953 Category Network Development & Contracting Organization Carolina Complete Health Schedule Full-time
Description:

Position Purpose: Review and audit inbound and completed provider data requests to ensure accuracy, completeness and compliance. Review and resolve complex issues and communicate status reports to management.

  • Review inbound provider data requests to ensure accuracy, completeness and compliance and route to appropriate cross functional teams
  • Audit completed requests for accuracy and compliance with standards
  • Analyze and advise management of personnel and workflow issues and suggested resolutions
  • Review, investigate or research issues and generate reports for internal and external customers
  • Maintain and update provider data applications and coordinate the data verification process for providers enrolled in networks
  • Oversee and coordinate operational and administrative activities associated with provider relations, including provider education and liaison responsibilities, marketing and promotion, and facilitation of credentialing and certification
  • Complete analyses and audit analysis reports, inventory reports and submitter’s status reports
  • Maintain standard operating procedures and assist management in implementing departmental policies and procedures
  • Collaborate with various cross-functional teams to audit data exchanges
  • Assist with various complex questions and training opportunities

  • Qualifications:


    Education/Experience: High school diploma or equivalent. 5+ years of provider data or network administration experience, preferably in managed care. Proficient in Microsoft Office applications, preferably Access and Excel. Database management, reporting, auditing and analysis preferred. Associate’s degree in healthcare or a related field preferred.

    Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

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