Manage operational aspects of Provider Network Department including all aspects of team and individual proficiency in areas such as: provider data management, ensuring data integrity, compliance, reporting, internal audit, the emerging importance of encounter data impacts, provider and provider network evaluation, set-up and maintenance, and claims and other production queues. Strong focus on data optimization/extraction/taxonomy for current and future business needs across all lines of business. Work collaboratively with leadership in Provider Network Department, as well as many other external departments and cross-functional teams.
Work Experience: 5 years in healthcare or healthcare operations, and 3 years of management overseeing operational areas. Experience in the management of provider data preferred.
Education, Certificates, Licenses: Bachelor’s Degree in related field or equivalent combination of education and experience.
Knowledge: Advanced knowledge of provider reimbursement and reimbursement methodologies, provider relations, or provider partnership activities in relevant markets and geography.
Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 10% of the time.
Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.
Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.
PacificSource Health Plans is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, age.