Provider File Maintenance Specialist Jobs (NOW HIRING)

Job Description:

Summary:

The incumbent directs the team responsible for maintaining the integrity and quality of the provider files. This role oversees the training, coordination of all departmental workflows, prioritization of assignments, interaction with external customers as well as effectively communicating requirements amongst various cross-divisional teams. The Supervisor effectively leads the Provider File Management (PFM) team in such a way as to ensure quality delivery within time and budget constraints.

Essential Accountabilities:

• Supervises technical and analytical work of assigned PFM staff. Interviews, selects and trains staff to achieve or exceed established standards of performance. Monitors and coaches PFM employees.

• Coordinates the prioritization and scheduling of work assignments and projects, including oversight of and responsibility for all provider file activity and day to day operations of the unit.

• Initiates and leads analyses within the department to drive innovative approaches to process improvement strategies.

• Represents Provider Network Engagement (PNE) in Azure DevOps request prioritization teams, and Maintenance of Business (MOB) work, ensures appropriate prioritization of PNE works (and provides guidance and support to justify critical nature of work).

• Analyzes and resolves errors/trends, make appropriate corrections. Troubleshoots provider affiliation issues referred by IDNs, Customer Service, Provider Relations.

• Acts as a resource subject matter expert for provider data management requirements.

• Prepares reports and detailed business documents as required.

• Ensures that projects and provider data management administration tasks meet time, cost, and quality parameters.

• Identifies and installs quality monitoring tools and processes.

• Drives process improvements, leverages technology effectively, collaborates across stakeholders, contributes to key meetings, and supports team development and knowledge sharing.

• Identifies provider file/data quality trends through analysis and collaboration.

• Interfaces with IT to implement new technology requirements.

• Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies' mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs.

• Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.

• Maintains knowledge of all relevant legislative and regulatory mandates and ensures that all activities are in compliance with these requirements.

• Conducts periodic staff meetings to include timely distribution and education related to departmental and Ethics/Compliance information.

• Regular and reliable attendance is expected and required.

• Performs other duties and functions as assigned by management.

Minimum Qualifications:

• 3 years of relevant experience, one (1) of which are in a defined project lead and/or leadership role, required.

• Bachelor's Degree in Computer Science, Information Technology or related. In lieu of degree, a minimum of six (6) additional years relevant experience required.

• Demonstrated leadership and supervisory experience, prior experience supervising, managing people and/or projects, or indirectly leading teams.

• Ability to assess risk and prioritize planned activities, analyze complex issues, and make data-driven decisions for effective solutions with stakeholders' input.

• Demonstrated experience with project design, development, creation of metrics, and governance processes required to manage projects.

• Knowledge of overall Health Plan operations, contract benefits, and provider databases.

• Demonstrated expertise in structured systems analysis and design, data gathering techniques and management information systems.

• Expertise in relevant configuration programming, job control languages and structured configuration programming techniques.

• Strong project management and communication skills.

Physical Requirements:

• Ability to work prolonged periods sitting and/or standing at a workstation and working on a computer.

• Ability to work while sitting and/or standing at a workstation viewing a computer and using a keyboard, mouse, and/or phone for three (3) or more hours at a time.

• Ability to work in a home office for continuous periods of time for business continuity.

• Ability to travel across the Health Plan service region for meetings and/or trainings as needed.

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In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position.

Equal Opportunity Employer

Compensation Range(s):

Grade E3: Minimum $62,400 - Maximum $106,929

The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position's minimum qualifications, in addition to internal equity. The posted salary range reflects just one component of our total rewards package. Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays.

Please note: The opportunity for remote work may be possible for all jobs posted by the Univera Healthcare Talent Acquisition team. This decision is made on a case-by-case basis.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.