Job Description

Job Title: Senior Provider Data and Analytics Manager
Job Location: Washington

Responsibilities:

  • Oversee all reporting and data requirements for the health plan
  • Encounter reporting development and submission
  • Network development reporting
  • Provider data reporting and data comparisons for start up and ongoing operations
  • Extractions for directory submissions
  • Maintenance of data among multiple systems for integrity, operational scorecards, and other reporting and data requirements as defined by the plan
  • Direct oversight for Credentialing function (in partnership with QI) ensuring the process between credentialing and provider data integrity is seamless
  • Direct oversight of encounter error corrections, processing and reporting to meet State established acceptance rate
  • Responsible for all system implementations, development of business requirements, and system enhancement projects
  • Create, validate, and produce reports for state or other reporting needs
  • Direct oversight and coordination of GeoAccess reports and provider network reports required for submission to the state on an ongoing basis
  • Coordinate with Provider Relations and Claims to address Network Data errors and claims processing issues
  • Develop reports to assure data integrity among multiple data sources and works with accountable departments to resolve issues
  • Responsible for working with the QI department in the development of QI and credentialing reports
  • Accountable for any ad hoc reporting needs as defined by the health plan
  • May oversee Provider Data department staff and activities including provider set up forms, maintenance of provider records, and audit provider data records

Required Qualifications:

  • Bachelor's degree in a related area or equivalent experience
  • Seven+ years of experience in a similar position in a health plan or network setting
  • Project management, claims management/processing, and implementation experience
  • Must be able to develop system business requirements

QBH#: 2320

Application Instructions

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