Manager, Provider Data Operations

Description and Requirements

The Manager, Provider Data Operations functions as an advisor to a department, function, or organizational unit regarding duties, responsibilities, projects and/or activities. He/she is actively involved in daily operations of the Provider Data team only when required to meet schedules or resolve problems. His/her primary role is to implement and execute policies and to ensure that departmental priorities, schedules, and deliverables are attained. This level typically has responsibility for budgeting, controlling costs, planning, scheduling, and procedural changes. The Manager, Provider Data Operations embodies Healthfirst's Culture Drivers through his/her workplace behavior, while promoting and reinforcing subordinate behavior that is consistent with Healthfirst's desired culture.

Work Schedule

This position requires three days per week in office (Tues/Wed/Thurs) at either: 1101 Greenwood Blvd. Lake Mary, FL. or 100 Church St. New York, NY.

Duties & Responsibilities:

• Manages inbound requests for Provider Operations tasks including the daily Intake of tasks received from Provider Network and ensures timely completion of those tasks with minimal re-work.
• Identifies opportunities for increased efficiency while maintaining high quality standards in alignment with company goals, regulatory compliance, and security requirements.
• Establish clear and quantifiable policies & expectations for department Team Members related to productivity and quality of work in accordance with company goals and compliance requirements.
• Maintain visibility of daily production activities including volume of work, completion times, and quality of outcomes through Individual and aggregate Team Performance Reporting.

• Complete tasks and assignments on time and within established service level agreements.
• Meet with Team Members no less than monthly to discuss team performance and address trends requiring improvement.
• Recognize and reward employees for accomplishments and leverage performance improvement plans to ensure accountability as needed.
• Collaborate with Stakeholders across the operations to implement process improvements across teams.
• Establish individual performance goals for all team members.

• Attend meetings and communicate relevant changes and updates as appropriate.
• Hire, coach, and develop staff for advancement.
• Attend to any human resource related matters within area of responsibility by collaborating with Sr. Leadership, Employee Connect, and HRBP
• Collaborate with Operational Audit, Policy & Process Documentation, and Training Delivery Teams to ensure Job Aids, Training Materials and available tools and reference guides are aligned with the production environment and useful to team members.
• Additional duties as assigned

• Moderate experience working with MS Office Suite to include adding/deleting rows/columns, creating simple formulas, creating standardized reports, and creating letters/memos.
• Experience reading and interpreting data, identifying trends, recommending proactive solutions, and effectively communicating them to senior management.
• Prior experience in a management role providing team leadership of exempt and non-exempt staff, including experience administering performance reviews, coaching, and disciplinary action, as well as conducting interviews, hiring, employee on-boarding, and terminations.

• Experience evaluating risk, making sound decisions, and solving problems quickly and effectively.
• Experience in an Operations area, managing high volume and complex repetitive tasks, in quality driven environment.
• Experience dynamically adjusting day to day operations and effectively leveraging resources to accommodate unexpected, time sensitive tasks.
• Previous experience managing competing priorities with effective communication.
• Associate Degree from an accredited institution or equivalent experience.

• Knowledge of Medicare, Medicaid, Commercial and Consumer insurance guidelines

• Previous experience collaborating on cross-functional processes as a subject matter expert (SME)

• Experience working in health care industry specific to provider operations, including Provider Data Management, and/or Network Management.
• Proficiency in medical terminology, claims workflows, and claims fundamentals.
• Experience with improving and automating manual processes to reduce completion time, while minimizing errors, eliminating rework, and meeting quality expectations.
• Experience in a Customer Service Environment with Internal and/or External business partners.
• Experience with MS Visio and Process Mapping.
• Basic understanding of Healthfirst systems such as: MHS, Macess, and Healthfirst Pega-Systems.
• Understanding of Tableau Software, Qlik Cloud, HealthEdge Payer, Claims or Provider Data Management Modules.

• Bachelor's degree from an accredited institution or equivalent experience.