Provider Data Management Senior Associate

Remote - USA

Full Time Senior-level / Expert
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Clover Health

With most plans at $0/month, Clover is a Medicare Advantage plan giving members more coverage for less cost, including dental, vision, hearing & more.

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Clover is reinventing health insurance by working to keep people healthier.

We value diversity — in backgrounds and in experiences. Healthcare is a universal concern, and we need people from all backgrounds and swaths of life to help build the future of healthcare. Clover's engineering team is empathetic, caring, and supportive. We are deliberate and self-reflective about the kind of engineering team and culture that we are building, seeking engineers that are not only strong in their own aptitudes but care deeply about supporting each other's growth.

As a Provider Data Management Senior Associate, you will:

  • Work to continuously improve provider data demographic and relationship accuracy, both in our claims transaction system and online directory.
  • Engage and partner cross-functionally with leaders from Claims, Configuration, Compliance, and Contracting, to ensure company goals are successfully met.
  • Perform workflow analysis to monitor consistency and efficiency in processes and procedures, and identify and re-design inefficient workflows and gaps within Provider Data Operations processes.
  • Support implementation and maintenance of Direct Contracting Entity program.
  • Establish audit protocols to increase provider data accuracy. 
  • Train new team members and be a point of contact for questions.
  • Develop procedures and lead projects to improve provider data accuracy.
  • Assist providers as necessary with problem resolution.
  • Research, resolve, and respond to provider-related requests received through Salesforce.
  • Investigate and respond to complex provider-related issues with regard to claims payment and provider directory issues.
  • Outreach to provider groups to request updated provider rosters. 
  • Lead monthly validation process to review and approve printed provider directory proofs.
  • Assist in identifying opportunities for process and technology improvements.
  • Escalate issues to PDM Manager.

You will love this job if:

  • You have strong analytical skills, and enjoy improving upon process and operations.
  • You're detail oriented and can develop processes and reports to quickly identify outlier data elements.
  • You are a creature of process; understanding the need to optimize and organize data collection, cleansing, sharing, and ingestion.
  • You have a critical and analytical mindset. You understand how all the components of a process fit together and believe in the value of making data-driven decisions; you continuously monitor the efficacy of your programs through metrics.

You should get in touch if:

  • You have knowledge of provider demographic and relationship data.
  • You have 3+ years of healthcare experience, especially in healthcare administration, and/or with handling provider demographic data (specifically with NPPES and CAQH).  
  • You have exceptional organizational skills with utmost attention to detail and data integrity. 
  • You are technologically savvy, with an understanding of various data wrangling methods and tools to best position yourself and the team for efficiency (i.e. Excel, SQL, etc.).
  • You are able to work collaboratively with field and operations teams to gather necessary information for the provider demographic data ingestion process.
  • You are able to work cross functionally to implement process adjustments and improvements. 
  • You have a thorough understanding of healthcare administration/provider data topics and data elements.

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Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. We are an E-Verify company.

About Clover: We are reinventing health insurance by combining the power of data with human empathy to keep our members healthier. We believe the healthcare system is broken, so we've created custom software and analytics to empower our clinical staff to intervene and provide personalized care to the people who need it most.

We always put our members first, and our success as a team is measured by the quality of life of the people we serve. Those who work at Clover are passionate and mission-driven individuals with diverse areas of expertise, working together to solve the most complicated problem in the world: healthcare.

From Clover’s inception, Diversity & Inclusion have always been key to our success. We are an Equal Opportunity Employer and our employees are people with different strengths, experiences and backgrounds, who share a passion for improving people's lives. Diversity not only includes race and gender identity, but also age, disability status, veteran status, sexual orientation, religion and many other parts of one’s identity. All of our employee’s points of view are key to our success, and inclusion is everyone's responsibility.

Tags: Analytics Compliance Data-driven Excel Point of contact Research Salesforce SQL

Perks/benefits: Insurance

Region: North America
Country: United States
Job stats:  1  0  0
Category: Data Jobs
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