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Director, Provider Data Management

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Director, Provider Data Management

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Description

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.

Work Location: Atlanta Office

Position Purpose: Oversee all the provider data management activities for the health plan. Reporting and data requirements for the health plan, including but not be limited to such activities as: encounter reporting development and submission, network development reporting, provider data reporting and data comparisons for start up and ongoing operations, extractions for directory submissions, maintenance of data among multiple systems for integrity, operational scorecards, and other reporting and data requirements as defined by the plan.

  • Oversee Provider Data Department including provider set up forms, maintenance of provider records and audit provider data records as well as management of all coordinator staff.
  • Direct oversight for Credentialing function (in partnership with QI) ensuring the process between credentialing and provider data integrity is seamless.
  • Create, validate and produce reports for state or other reporting needs.
  • Support and participate in production of GeoAccess reports and provider network reports required for submission to the state on an ongoing basis.
  • Coordinate with Provider Relations and Claims to address Network Data errors.
  • Develop reports to assure data integrity among multiple data sources and works with accountable departments to resolve issues.
  • Responsible for working with the QI department in the development of QI and credentialing reports.
  • Accountable for any ad hoc reporting needs as defined by the health plan.

Education/Experience: Bachelor's degree in Business, Healthcare Administration, related field, or equivalent experience. 7+ years of combined project management, business analysis and process improvement experience, preferably in the healthcare, managed care, or government programs industry. Experience in a management role, including responsibility for hiring, training, assigning work, and performance management of direct reports. Provider data management and/or contracting experience preferred.

Pay Range: $108,700.00 - $201,000.00 per year

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives.


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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