Team Lead, Provider Data Integrity – SQL/Provider Data Experience

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

📋 Description

• Oversee and provide support for the Provider Data Integrity (PDI) team.

• Manage essential PDI operations for the Ohio provider panel, ensuring provider information is accurate in relevant CareSource systems.

• Accurately and promptly process provider additions, terminations, and modifications.

• Supervise, mentor, guide, and train team members.

• Offer direction and oversight for the setup and maintenance of provider information.

• Ensure adherence to provider contract documents as well as state and regulatory standards.

• Address inquiries via calls and emails from both internal and external customers.

• Collaborate with Provider Relations and Credentialing to finalize applications that are missing components.

• Monitor PDI work queues to ensure Turn Around Times are achieved.

• Track file aging, assist staff in closing files, meet Service Level Agreements, and report trends to the Manager.

• Participate in the Operations Management Team and its meetings.

• Support performance evaluations, hiring processes, and disciplinary actions.

• Maintain timesheets for non-exempt employees.

• Coordinate data entry tasks, problem-solving initiatives, and project management.

• Oversee quality reviews, performance feedback, disciplinary matters, and merit/bonus appraisal assessments.

• Develop, review, update, and enforce company and departmental policies and procedures.

• Provide mentoring, training, and continuous education on optimal performance and Standards of Excellence.

• Execute additional job-related tasks as requested.

⛳️ Requirements

• An Associate’s Degree in business or a related field, or equivalent relevant work experience is mandatory.

• A minimum of three (3) years of experience in provider data management or supervisory roles is essential.

• Previous experience in a managed care organization is preferred.

• Intermediate proficiency in computer skills is required.

• Competence in Microsoft Word, Outlook, and Excel is necessary.

• Ability to work both independently and collaboratively within a team environment.

• Skills in training and teaching are important.

• Attention to detail is crucial.

• Capability to effectively support a range of personalities and work styles.

• Familiarity with the healthcare sector is beneficial.

• Knowledge of Medicaid is advantageous.

• Strong critical listening and thinking skills are required.

• Strategic management skills are necessary.

• Proficient use of proper grammar is expected.

• Technical writing skills are essential.

• Effective time management skills are required.

• Proper phone etiquette is important.

• A customer service-oriented mindset is necessary.

• Strong decision-making and problem-solving skills are essential.

• Knowledge of medical terminology is beneficial.

• Ability to identify and suggest process improvements is expected.

• No licensure or certification is required.

🏝️ Benefits

• Bonuses linked to both company and individual performance.

• A substantial and comprehensive total rewards package.

• Support for employee total well-being.