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Position : Network Management Manager Provider Data Maintenance

Location : Remote (Must reside in NY / NJ / CT)

Schedule : Monday - Friday 9am-5pm

Compensation : $102,600 - $115,400 annual salary

Summary :

The Network Provider Data Maintenance Manager will be required to oversee and manage the Data Maintenance Team performance, coordinating and managing all aspects of critical provider information on all claims and provider databases. This includes synchronizing data among multiple systems and applications, ensuring business rules are set and enforced. Collaborate with all needed parties to ensure adherence to business and system requirements of customers as it pertains to contracting, network management and credentialing. Manages the development, implementation, and maintenance of provider data in the provider data system. The Network Management Provider Data Maintenance Manager interfaces with the Provider Contracting Department, Provider Network Operations Department, Credentialing Department, Claims Department, Provider Relations Team, and other ancillary departments (e.g., Claims) to develop data integrity to support effective network operations and strategies for provide data maintenance under the direction of the Director of Network Ops. Organizational expert in responding to regulatory reporting around provider data. Engages IT and other departments to implement changes to business rules with the support of the Network Ops Director. The Manager will be responsible for Provider Maintenance special projects, reviewing contracts, letters of agreement and amendments for implementation, in addition to creating, or updating provider and(or) vendor records, and working closely to assist Provider Network Operations staff on provider data related issues and strategies. The Network Provider Data Maintenance Manager must have experience in data analytics , experience with Cognizant and Health Cloud.

Essential Job Functions :

• Creation and maintenance of all provider records within the health plan system(s) includes :
• Leader in demographic data migration to V12 / Salesforce
• Participates in all implementation aspects and directs team on all responsibilities for success
• Leader in demographic interface for claims adjudication and payment w / vendor (ILS / Cognizant)
• Manages in partnership with finance the EFT set up / process ; ensuring EFT info is set up and shared with
• Manages and oversees Data Team roles and
• Manage the daily data migration from delegated rosters to the provider platform, V12.
• Setup of demographic and specialty information, panel, line of business and fee schedules
• Performs data entry accurately and
• Audit current provider contracts and data to ensure they are up to date.
• Act as subject matter expert for other departments as it relates to provider contracts and
• Trouble shoot and identify root cause of problems and collaborate with other departments to resolve provider data
• Identifies and documents opportunities for provider education and communicates to network
• Participates in standing meetings as necessary, including but not limited to provider relations, contracting, network development, team building, network
• Work to create most effective provider maintenance reports and ensure they are assigned the correct
• Prepares correspondence to providers concerning their provider data issues and requests for more

Provider Data Coordination

Provider Data Analysis

Qualifications & Minimum Requirements

VillageCare is an Equal Opportunity Employer.