Senior Manager, Provider Data & Analytics

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.
 

Position Purpose: Oversee all provider network operations data activities, including provider enrollment, data maintenance, oversight of credentialing, provider data directory accuracy and audits. Responsible for developing policies and procedures for plan responsibilities relating to provider data enrollment, maintenance, and accuracy, including but not be limited to such activities as: network development reporting, provider data reporting and data comparisons, extractions for directory submissions and regulatory reporting, maintenance of data among multiple systems for integrity, operational scorecards, and other reporting and data requirements as defined by the plan.

• Oversee Network Operations/Provider Data staff and activities and all activities relating to provider data, including but not limited to, provider enrollment, provider data maintenance and changes, and provider directory accuracy and audit. 
• Direct oversight of corporate enrollment process, including credentialing, ensuring appropriate action is addressed to meet the State established timeframes.
• Lead, supervise, oversee and develop a team of provider data staff including contract coordinators and business analysts.
• Develop and update policies and procedures, desktop process, workflows and business rules.
• Assist with network development reporting, provider data reporting and data comparisons
• Participate in state audits and responses to state inquiries
• Create, validate and produce reports for state or other reporting needs
• 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
• Accountable for any ad hoc provider data reporting needs as defined by the health plan.

Education/Experience: Bachelor's degree in a related area or equivalent experience. 7+ years of experience in a similar position in a health plan or network setting. Project management, claims management/processing, and implementation experience required. Must be able to develop system business requirements.

 

Preferred Skills: 

• Experience overseeing and reconciling provider data.
• Exceptional organizational skills with the ability to manage multiple projects and priorities simultaneously.
• Strong leadership capabilities, with a proven track record of holding team members accountable and driving results.
• Demonstrated expertise in process improvement, identifying inefficiencies and implementing streamlined workflows to enhance overall team performance and productivity.
• Ability to develop and maintain structured processes, ensuring consistency and continuous improvement across …