Mgr, Provider Data Operations Implementation (MCO Experience a must)

Job Summary:

The Manager, Provider Data Operations Implementation is responsible for overseeing the implementation and integration of provider data into company’s provider data management system. This role ensures the accurate, timely, and compliant processing of provider data, and plays a key role in streamlining day-to-day operations post implementation. (Data operations includes experience in provider data, enrollment, health plan life cycle etc).

Essential Functions:

• Manage integration of provider data by implementing solutions that effectively process provider data through credentialing, contract administration and load into core provider data management system. Ensure that the integration process is executed in a timely, accurate, and compliant manner.
• Collaborate with cross-functional teams (e.g., IT, Provider Relations, Claims, Compliance) to ensure smooth execution of provider data initiatives. Track progress, manage timelines, and ensure that all stakeholders are aligned on objectives and deliverables.
• Oversee the validation, accuracy, and consistency of provider data throughout the implementation process. Ensure that data is accurate, complete, and compliant with industry regulations (e.g., HIPAA, CMS guidelines).
• Support, guide, and mentor junior team members in provider data operations, ensuring the team adheres to best practices. Provide training on systems, processes, and regulatory requirements as needed.
• Continuously evaluate and improve workflows and processes related to the provider data implementation process.
• Ensure all provider data operations comply with applicable regulations and industry standards.
• Identify and address issues or challenges that arise during the provider data implementation process. Serve as a point of contact for resolving operational and data-related issues and escalate as necessary.
• Assist in the preparation of regular reports and dashboards to track the progress of provider data initiatives. Document processes and maintain detailed records of data integration activities. Prepare and present status updates to executive leadership.
• Communicate regularly with internal stakeholders and external vendors to ensure timely resolution of issues and smooth execution of provider data projects. Provide updates on project timelines, risks, and milestones to senior management.
• Perform any other job duties as requested

Education and Experience:

• Bachelor’s degree in Computer Science, Healthcare Administration, Business Administration, Information Technology, a related field, or equivalent years of relevant work experience is required
• Five (5) years of experience in healthcare data operations or implementation, with a focus on provider data management within a managed care environment is required
• Previous leadership experience is required
• Experience working with cross-functional teams to implement data-driven projects and initiatives

Competencies, Knowledge and Skills:

• In-depth knowledge of healthcare provider data structures, including credentialing, contracting, and claims data management. Understanding of relevant regulations (e.g., HIPAA, CMS guidelines) and industry standards
• Familiarity with healthcare management systems, provider data platforms, and/or credentialing processes is a plus
• Ability to coordinate multiple tasks, manage timelines, and monitor project progress to ensure on-time and on-budget delivery
• Strong ability to analyze provider data for accuracy, identify discrepancies, and implement corrective actions. Experience in identifying trends and issues to drive operational improvements.
• Proactive approach to identifying issues, troubleshooting challenges, and resolving operational roadblocks. Strong decision-making and critical thinking skills.
• Excellent written and verbal communication skills, with the ability to clearly present data, project updates, and process changes to internal stakeholders and leadership
• High level of attention to detail to ensure data accuracy, compliance, and timely implementation
• Ability to adapt to changing requirements, processes, and priorities in a fast-paced environment
• Proficiency with Microsoft Office Suite (Excel, Word, PowerPoint)

Licensure and Certification:

• None

Working Conditions:

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

Compensation Range:

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.

Compensation Type (hourly/salary):

Organization Level Competencies

• Fostering a Collaborative Workplace Culture

• Cultivate Partnerships

• Develop Self and Others

• Drive Execution

• Influence Others

• Pursue Personal Excellence

• Understand the Business