Manager, Provider File Manitenance

Manager, Provider File Maintenance

The Provider File Maintenance (PFM) Manager leads a team responsible for maintaining provider records, ensuring data quality, supporting credentialing, and network operations, and coordinating with internal and external stakeholders to meet compliance, operational, and reporting requirements. This role ensures provider information is updated timely and accurately to support claims processing, directory accuracy, regulatory obligations, and member experience.

Key Responsibilities :

• Manage day-to-day activities of the PFM team to ensure provider information is accurately and timely maintained.
• Monitor and assign workload, set priorities, and ensure turn-around time and quality targets are met.
• Work with provider relations, network development, compliance, credentialing, accounting, and / or claims departments to resolve provider data discrepancies.
• Establish and oversee quality control processes to ensure data integrity and regulatory compliance including, but not limited to, Centers for Medicare & Medicaid Services (CMS), state regulations, and provider directory accuracy requirements.
• Participate in system enhancements, testing, upgrades, and integration projects involving provider data.
• Support root-cause analysis for data-related issues and implement solutions to prevent recurrence.
• Respond to escalations related to provider data issues affecting claims processing, directory accuracy, and member / provider experience.
• Train, coach, and mentor staff to promote excellent performance and growth.
• Generate and analyze reports on team performance, error rates, and turnaround times.
• Review work processes to identify opportunities and implement improvements for handling or maintaining provider information.

Required Qualifications :

Preferred Qualifications :

Equal Opportunity Employer This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.