Director, Provider Information Management(Facets Experience Required)

Job Summary:

The Director, Provider Information Management, is responsible for provider data management operations across Health Partner Life Cycle (HPLC) and throughout the organization including delegated vendors, solution partners, and client plans.

Essential Functions:

• Initiate, develop, implement, optimize, and oversee provider data processes to ensure overall data quality, accuracy, completeness, and compliance with regulatory requirements
• Drive development and implementation of provider data interfaces, solutions, and auditable monitoring processes that include control and balance, exception handling, tracking, trending, and reporting
• Responsible for proactive analysis of operational, service, and performance metrics and proactive initiation of performance improvement activities across the organization to achieve provider data accuracy goals
• Develop and maintain departmental policies, procedures and controls governing provider data ensuring all policies and procedures and controls are in place, current, consistent across department and CareSource, and compliant with all legal, Federal, State and Accrediting standards
• Work collaboratively with stakeholders and auditors to support internal and external audits
• Ensure compliance with Model Audit Rules, State, Federal and Accrediting Agencies for all elements related to provider credentialing and data entry into claims system
• Lead active performance improvement initiatives to continually improve the level of productivity, performance, quality and compliance
• Perform continuous review of business workflows to improve productivity and ensure provider satisfaction
• Assure the confidentiality of provider information and ensure all provider information (electronic and hard copy) is secured
• Work closely with management to prepare and execute data management plans to manage projects from beginning to end
• Work with business areas and IT to ensure integrity and proper integration of all sources of enterprise data
• Serve on CareSource-wide committees, acting as liaison between Health Partners Life Cycle (HPLC) department and user community, acts as liaison between CareSource and vendor community as directed by the HPLC department head
• Collaborate with business partners and senior leadership to prioritize data-driven projects, and to provide quality information to support business processes
• Manage complex initiatives that significantly affect business results and require a large degree of cross functional participation/coordination
• Establish and maintain relationships to ensure efficient and effective use of departmental and company resources
• Responsible for hiring, training, coaching and developing direct reports
• Responsible for completing performance appraisals and disciplinary actions of direct reports
• Responsible for guiding and directing staff through complex projects
• Perform any other job duties as requested

Education and Experience:

• Bachelor's Degree in information technology, business intelligence, business or related field, or equivalent years of relevant work experience is required
• Master's Degree in business, information technology, or related field is preferred
• Minimum of ten (10) years of experience in some combination of provider data operations, data management, business intelligence (BI), data warehousing or other similar discipline is required
• Minimum of five (5) years of management experience in provider data operations space at health insurance plan is required, preferably covering Medicaid, Marketplace and Medicare lines of business
• Experience in managing provider directory operations is required
• Managed Care or Healthcare experience is required
• Experience implementing provider data management system is preferred
• Experience planning, developing, and executing provider data migration from one health plan to another is preferred

Competencies, Knowledge and Skills:

• Knowledge of provider data management systems
• Knowledge of provider data operations in Cognizant Facets system
• Knowledge of claims to provider matching mechanism and health plan claim processing
• Knowledge of regulations governing provider data operations at health plans
• Exceptional MS Excel and Access skills; proficiency in using SQL tools, ability to independently extract; match and analyze data
• Extensive knowledge in strategic and tactical planning
• Proven strong, dynamic leadership skills, with ability to manage across various levels of the organization
• Ability to present information clearly across a variety of stakeholders
• Strong managerial and technical skills
• Diplomatic skills to negotiate, collaborate and influence stakeholders
• Strong service orientation and consulting skills
• Proven ability to work collaboratively with all levels of management
• Ability to lead mission-critical, high visibility projects
• Proven ability to handle multiple complex priorities within a changing environment
• Demonstrated ability to be innovative and resourceful in problem resolution
• Proven ability to routinely meet or exceed business expectations
• Strong leadership and management skills
• Ability to direct multiple individuals while managing multiple tasks
• Strong communications skills (both written and verbal)

Licensure and Certification:

• None

Working Conditions:

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

Compensation Range:
$130,300.00 - $228,100.00 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. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type:
Salary

Competencies:
- Create an Inclusive Environment
- Cultivate Partnerships
- Develop Self and Others
- Drive Execution
- Influence Others
- Pursue Personal Excellence
- Understand the Business

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer, including disability and veteran status. We are committed to a diverse and inclusive work environment.