Senior Manager, Provider Data Operations – Attribution Integrity

This is a fully remote position, open to applicants in Arizona, +24 more states.

📋 Description

• Lead the processes for attribution, membership, and provider data governance.

• Supervise the resolution of provider data and attribution challenges that impact member assignments, reporting accuracy, and downstream operations.

• Collaborate with health plan leaders, network teams, provider data teams, claims, compliance, marketing, operations, and technology partners.

• Execute projects that enhance business performance, fulfill regulatory requirements, and elevate customer experience.

• Ensure the accuracy of the provider directory, audit readiness, and regulatory validation through monitoring, documentation, and issue resolution.

• Identify recurring issues, root causes, and control deficiencies.

• Propel process enhancements that minimize rework and boost operational reliability.

• Maintain governance routines, process documentation, and coordination across functions.

⛳️ Requirements

• 7–10 years of relevant experience.

• 5+ years of experience in Medicaid, managed care operations, provider data, or healthcare analytics.

• Proficiency in SQL, advanced Excel, Power BI, Tableau, or similar analytical tools.

• Capability to independently investigate, analyze, and reconcile complex healthcare data.

• Skill in identifying root causes and proposing corrective measures.

• Experience in investigating and resolving provider data issues, including provider identifiers, affiliations, and contractual relationships.

• Background in coordinating cross-functional issue resolution and operational enhancements.

• Excellent communication skills with the ability to translate complex operational challenges into business risks, action plans, and responsibilities.

• Experience in managing provider attribution methodologies, governance, reporting, and operational execution.

• Familiarity with leveraging QNXT and Medicaid Data Warehouse (MDW) data.

• Experience in investigating discrepancies in member attribution or provider assignment.

• Proven track record in managing, validating, or reconciling provider rosters.

• Experience in managing provider data, directory accuracy, or related operational challenges across multiple teams.

• Bachelor's degree or equivalent professional experience.

🏝️ Benefits

• Medical, dental, and vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• Additional resources supporting physical, emotional, and financial well-being.

• CVS Health bonus, commission, or short-term incentive program.

• Equity award program.