Director

Job summary

The U.S. Healthcare Provider Data Management Specialist is an individual contributor role responsible for supporting Operations and participating in building new solutions and services for Provider Data Management line of business. This position involves deep subject matter expertise in Provider Data Management and Credentialing operations, identifying, and implementing cost-saving measures, having experience and exposure to transformational projects relating to Provider Data Management. The Provider Data Management Specialist will ensure data integrity, compliance with regulatory requirements, and efficient processes for provider data management for health plan customers.

Duties and responsibilities

Leadership, Awareness:

• Exceptional in PDM domain and understands the delivery and solutions landscape in PDM domain.
• A self-motivating leader who can ideate, implement, help develop and execute innovative strategies for healthcare Provider Data Management operations to achieve business objectives and improve overall efficiency and effectiveness.
• Stay informed about industry trends, advancements in provider data management technologies, and best practices. Continuously seek opportunities for process improvement and implement changes accordingly.

Provider Data Management:

• Manage projects related to provider data management, including system enhancements, process improvements, and data migration initiatives.
• Manage provider credentialing and enrollment processes, including verification of licenses, certifications, and accreditations.
• Collaborate with IT teams to ensure optimal functionality and usability of provider data management systems and software.
• Design reports and presentations on provider data metrics, trends, and performance indicators for management and stakeholders.

Data Governance:

• Develop and implement data governance strategies and policies to ensure consistent and standardized management of provider data across the organization. Establish data quality metrics and monitor data accuracy and completeness.

Stakeholder Management:

• Collaborate with internal stakeholders, including contracting, network management, claims, and other departments, to ensure accurate provider data for operational and reporting needs. Address and resolve provider data-related issues and inquiries.
• Proficient in collaborating and working through multiple internal functions (Technology, CRM, Operations and Sales). Take responsibility for driving transformational projects and for cross-selling new services to clients.

Compliance and Regulatory Adherence:

• Ensure compliance with federal, state, and local regulations related to healthcare PDM, including but not limited to HIPAA, HIPAA, HITECH Act, NSA, and ACA .
• Develop and maintain policies and procedures that promote adherence to regulatory requirements, conducting regular audits and assessments to identify and address compliance gaps.
• Keep up to date with changes in healthcare regulations and PDM policies, providing guidance and training to staff members to ensure awareness and compliance.

Performance Reporting & Continuous Improvements:

• Develop and maintain performance metrics and key performance indicators (KPIs) for provider data management operations. Prepare and present regular reports on data accuracy, timeliness, and process efficiency to management.
• Stay informed about industry trends, advancements in provider data management technologies, and best practices. Continuously seek opportunities for process improvement and implement changes accordingly

We are Sagility 04

Skills & competencies

• Excellent collaboration and influencing skills and ability to work in a metricized organization.
• Strong leadership and managerial skills with a proven track record of successfully leading and developing high-performing teams.
• Excellent analytical, problem-solving, and decision-making abilities.
• Exceptional communication and interpersonal skills, with the ability to collaborate effectively with internal and external stakeholders.
• Strong understanding of compliance requirements and experience in ensuring adherence to regulations.
• Proficiency in using PDM software, data analysis tools, and Microsoft Office Suite.

Minimum education and experience required

• Bachelor's degree in healthcare administration, business administration, or a related field. A master's degree is preferred.
• An overall U.S healthcare experience between 18+ years with extensive operational experience (typically 10+ years in PDM) Provider Data Management or a related field.
• In-depth knowledge of Provider recruitment, provider data setup and management, data validation and credentialing/re-credentialing processes for health plans.
• Understanding of provider outreach operations for validating provider data.
• Understanding of provider credentialing and enrollment processes, including verification of professional licenses, certifications, and accreditations, to ensure compliance with regulatory requirements.