Mgr, Provider Data Operations Implementation (MCO Experience a must)

CareSource Management Services LLC • Dayton, OH • 4h ago

Job Summary:
The Manager, Provider Data Operations Implementation is responsible for overseeing the implementation and integration of provider data into company's provider data management system. This role ensures the accurate, timely, and compliant processing of provider data, and plays a key role in streamlining day-to-day operations post implementation. (Data operations includes experience in provider data, enrollment, health plan life cycle etc).
Essential Functions:
Manage integration of provider data by implementing solutions that effectively process provider data through credentialing, contract administration and load into core provider data management system. Ensure that the integration process is executed in a timely, accurate, and compliant manner.
Collaborate with cross-functional teams (e.g., IT, Provider Relations, Claims, Compliance) to ensure smooth execution of provider data initiatives. Track progress, manage timelines, and ensure that all stakeholders are aligned on objectives and deliverables.
Oversee the validation, accuracy, and consistency of provider data throughout the implementation process. Ensure that data is accurate, complete, and compliant with industry regulations (e.g., HIPAA, CMS guidelines).
Support, guide, and mentor junior team members in provider data operations, ensuring the team adheres to best practices. Provide training on systems, processes, and regulatory requirements as needed.
Continuously evaluate and improve workflows and processes related to the provider data implementation process.
Ensure all provider data operations comply with applicable regulations and industry standards.
Identify and address issues or challenges that arise during the provider data implementation process. Serve as a point of contact for resolving operational and data-related issues and escalate as necessary.
Assist in the preparation of regular reports and dashboards to track the progress of provider data initiatives. Document processes and maintain detailed records of data integration activities. Prepare and present status updates to executive leadership.
Communicate regularly with internal stakeholders and external vendors to ensure timely resolution of issues and smooth execution of provider data projects. Provide updates on project timelines, risks, and milestones to senior management.
Perform any other job duties as requested
Education and Experience:
Bachelor's degree in Computer Science, Healthcare Administration, Business Administration, Information Technology, a related field, or equivalent years of relevant work experience is required
Five (5) years of experience in healthcare data operations or implementation, with a focus on provider data management within a managed care environment is required
Previous leadership experience is required
Experience working with cross-functional teams to implement data-driven projects and initiatives
Competencies, Knowledge and Skills:
In-depth knowledge of healthcare provider data structures, including credentialing, contracting, and claims data management. Understanding of relevant regulations (e.g., HIPAA, CMS guidelines) and industry standards
Familiarity with healthcare management systems, provider data platforms, and/or credentialing processes is a plus
Ability to coordinate multiple tasks, manage timelines, and monitor project progress to ensure on-time and on-budget delivery
Strong ability to analyze provider data for accuracy, identify discrepancies, and implement corrective actions. Experience in identifying trends and issues to drive operational improvements.
Proactive approach to identifying issues, troubleshooting challenges, and resolving operational roadblocks. Strong decision-making and critical thinking skills.
Excellent written and verbal communication skills, with the ability to clearly present data, project updates, and process changes to internal

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