Payer Data Operations Manager

Company Description

Privia Health™ is a technology-driven, national physician enablement company that collaborates with medical groups, health plans, and health systems to optimize physician practices, improve patient experiences, and reward doctors for delivering high-value care in both in-person and virtual settings. The Privia Platform is led by top industry talent and exceptional physician leadership, and consists of scalable operations and end-to-end, cloud-based technology that reduces unnecessary healthcare costs, achieves better outcomes, and improves the health of patients and the well-being of providers.

Job Description

The role includes troubleshooting and resolving data issues across multidisciplinary teams responsible for ensuring the integrity and operational health of key data pipelines. This individual will own data procurement and related communication with payers, directing inquiries to the appropriate Privia health teams. This position involves interfacing directly with payers to understand and design payer data exchanges supporting Privia’s various business lines. Additionally, this role will research complex data and process questions, identify root causes, and interact closely with business users and technical resources to drive data-related decisions. Collaborate with medical economics, product engineering, and market-based teams, as well as external stakeholders, to drive operational excellence and maturation of data operations.

• Oversee completion and communication of all new payer contract data procurement activities
•  Monitor & manage successful completion of monthly data operations calendar; including awareness and
• proactive resolution of changes or break/fix scenarios
• Develop and achievement SLAs for new/update/break-fix scenarios
• Collaborate with engineering and analytics teams to align priorities, resolve issues, and adherence to internal standards
• Serve as the business owner for data processing activities and complete all necessary requirements to ensure implementation into appropriate environments
• Maintain close alignment with market representatives to proactively identify and address needs and drive value and efficiency
• Work across teams to perform appropriate audits to close the loop across internal systems and between Privia and payer partners –example: confirmation of receipt (file delivered) and verification of expected impact (e.g. payer processed data and measure result changed)
• Manage administrative processes required for payer portal access
• Monitor payer programs to proactively adjust data operations as needed.
• Lead meetings to influence and consult both internal and external business partners on data operations

Qualifications

• 3+ years of healthcare experience
• Experience in working with and understanding health plan data files, record layouts and data content
• including but not limited to: 1) attribution and care coordination files 2) detail claims files 3) detail quality files 4) payer …