Posted in Management 30+ days ago.
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Location: Maryland Heights, Missouri
Develops and directs overall strategy for effective completion of all transaction functions and management of provider data across the enterprise. Transactions include, but are not limited to, Contract Management and Execution, Credentialing, Pricing Configuration and Rate/Fee Schedules, Data Entry and Maintenance. Supports the needs of all downstream consumers of provider data such as claims processing, PCP and provider selection, reporting, encounters, electronic funds transfer (EFT)/electronic remittance advice (ERA) and reimbursement processes. Interfaces with organizational stakeholders regarding clinical and/or legal issues impacting, or impacted by provider data. Acts as subject matter expert for operating systems, supporting areas of accountability. Responsible for the development and maintenance of credentialing, contracting and reimbursement policies and procedures. Analyzes, monitors and acts upon trends and performance in the management of credentialing applications, contracts and provider data, individual staff productivity, and compliance with accreditation, state/federal, and customer requirements. Ensures timely execution of data management and flow of contract, rate and provider data to internal stakeholders and customer claims and clinical systems. Acts as primary subject matter expert during client and accrediting body audits. Provides leadership to establish a positive work environment that encourages employee participation in process improvement and commitment to department/company success. Holds budgetary accountability for the department.
General Job Information
TitleVP, Provider Data Management
Job FamilyNetwork Services Group (Inactive)
CountryUnited States of America
FLSA StatusUnited States of America (Exempt)
Recruiting Start Date6/17/2019
Date Requisition Created6/17/2019
Work ExperienceHealthcare, Managed Healthcare, Management/Leadership
EducationBachelors: Business Administration (Required), Masters
License and Certifications - Required
License and Certifications - PreferredPMP - Project Management Professional - Enterprise
Other Job Requirements
10 years of progressively responsible health care administration experience with strong preference for managed care experience.
5 or more years experience in a leadership role.
Bachelor's Degree in Business Administration
PMP Certification preferred
Master's Degree preferred
Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, comply and attest to the security responsibilities and security controls unique to their position.