[Hiring] Manager, Provider Data Management @Centene Corporation

Role Description

Within the Illinois Health Plan, the Provider Data Manager leads inventory, quality, production, and employee development while ensuring accountability, operational excellence, and a culture of trust. They partner across departments, drive process and system improvements, and leverage dashboards and data-driven insights to enhance efficiency, decision-making, and organizational outcomes.

• Responsible for managing activities that support all provider data management projects, policies, and procedures.
• Oversee provider contract setup activities and key initiatives related to operational issues for provider data maintenance.
• Support successful claims adjudication and directory accuracy.
• Work in conjunction with Credentialing for the setup and maintenance of all delegated entity arrangements.
• Oversee the development of reports to support the strategic and operational requirements of the department.
• Identify and implement value-added programs and initiatives that enhance network contracting for operational efficiency.
• Act as main contact for internal departments on projects requiring changes to business applications (provider, contracts, and claims).
• Meet with internal departments to identify project requirements and ensure satisfactory project completion.
• Work with Information Systems Department on special projects.
• Supervise staff and monitor their activity.
• Conduct reviews, one-on-ones, and provide monthly performance statistics to staff.
• Ensure staff meets both quality and production scores.
• Monitor and report turnaround times for production standards.
• Maintain detailed understanding of business applications specifically related to provider data management, provider reimbursement, and claims processing.
• Develop cost-benefit analysis for projects to assist in prioritization and project justification.
• Work with other internal departments to develop and update policies and procedures.
• Head meetings to discuss and communicate new business workflows and policies.
• Conduct training for both internal and external departments on provider data services policies and procedures.
• Resolve issues within internal departments related to interpretation of contracts or policies.
• Define reporting and information initiatives with internal and external customers to support strategic and operational requirements.
• Perform ad-hoc reporting as necessary to meet strategic and operational requirements.
• Maintain provider data integrity guidelines for delegated credentialing vendors.
• Prioritize data analysis projects based on business needs.
• Design and develop workflows, protocols, and process models for standard and ad-hoc reports.
• Maintain, test, and revise current data analysis programs.
• Manage input data from various internal and external sources.
• Perform other duties as assigned.
• Comply with all policies and standards.

Qualifications

• Strong history of leadership roles with direct reports.
• Proficient in Microsoft Office Suite, especially Excel, Visio, and Word.
• Good communication and meeting facilitation skills.
• Knowledge and experience working with Portico, Amisys, Directory, and other provider-related systems.

Requirements

• Bachelor’s degree required in business administration, Health Care, or a related field.
• 1-3 years management experience in a business setting required.
• Minimum of 3 years' experience working in a health care setting, preferably with a background in provider relations, provider data services, information technology, or claims operations.
• Experience developing new business processes and procedures.

Benefits

• Competitive pay.
• Health insurance.
• 401K and stock purchase plans.
• Tuition reimbursement.
• Paid time off plus holidays.
• Flexible approach to work with remote, hybrid, field, or office work schedules.