Provider Data Supervisor

This is a fully remote position, open to applicants in United States.

📋 Description

• Take ownership of the provider data management strategy and the annual operating plan.

• Convert organizational objectives into specific targets, roadmaps, KPIs, and resource allocation plans.

• Lead, mentor, and nurture the development of Provider Data Representatives.

• Establish performance goals, carry out evaluations and coaching, and encourage professional growth.

• Create governance structures for data standards, approvals, exception handling, and escalation processes.

• Manage provider demographics, participation, enrollment, credentialing attributes, and directory content across various systems.

• Ensure the prompt processing of provider updates, enrollments, terminations, and modifications.

• Verify records across operational systems to facilitate accurate claims payments and directory publication.

• Collaborate with Credentialing and Provider Relations to manage provider lifecycle data requirements.

• Oversee provider roster reconciliation and confirm rosters against credentialing, enrollment, claims, and directory information.

• Identify inconsistencies and coordinate remedial actions.

• Formulate reconciliation protocols, quality controls, duplicate/merge resolution guidelines, and maintain a master golden record.

• Collaborate with Provider Network, Contracting, Credentialing, Claims Operations, and Compliance teams.

• Address provider data discrepancies that impact reimbursement and support EDI/configuration updates and claims-impact analyses.

• Engage in enterprise provider-system and operational improvement initiatives.

• Facilitate provider data meetings and cross-functional workgroups.

• Ensure adherence to organizational policies, privacy/security standards, and relevant regulations.

• Maintain documentation that is audit-ready and participate in audits and quality assessments.

• Develop and implement corrective action strategies.

• Communicate statuses, risks, and recommendations to executive stakeholders.

• Prepare documentation for business reviews and governance committees.

⛳️ Requirements

• A minimum of 3 years of relevant experience.

• Proficiency in data integrity, documentation reporting, tracking, and quality assurance processes.

• MBI (T2) public trust requirement is necessary.

• Must successfully complete the employer’s identity verification process utilizing advanced biometrics and artificial intelligence.

• Expected to appear on camera during virtual interviews.

• No security clearance is required or needed to obtain.

• US citizenship is not a requirement.

• Travel is required: less than 10%.

🏝️ Benefits

• Options for medical plans, including some with Health Savings Accounts.

• Choices for dental plans.

• Vision plan options available.

• 401(k) plan with pre-tax and post-tax contributions, along with company matching.

• Flexible work weeks where feasible.

• Paid vacation, sick leave, and personal time off.

• Paid holidays.

• Paid parental leave.

• Paid military leave.

• Paid bereavement leave.

• Paid jury duty leave.

• Typically, 15 days of paid leave per calendar year for new employees.

• An additional 10 paid holidays per year.

• Up to 160 hours of paid family leave within a rolling 12-month period for eligible employees.

• Short- and long-term disability benefits.

• Life insurance coverage.

• Accidental death and dismemberment insurance.

• Personal accident insurance.

• Critical illness insurance.

• Business travel and accident insurance.