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Position Purpose: Oversee all reporting and data requirements for the health plan, including but not be limited to such activities as: encounter reporting development and submission, network development reporting, provider data reporting and data comparisons for start up and ongoing operations, extractions for directory submissions, maintenance of data among multiple systems for integrity, operational scorecards, and other reporting and data requirements as defined by the plan
· Direct oversight for Credentialing function (in partnership with QI) ensuring the process between credentialing and provider data integrity is seamless
· Direct oversight of encounter error corrections, processing and reporting to meet State established acceptance rate
· Responsible for all system implementations, development of business requirements, and system enhancement projects
· Create, validate and produce reports for state or other reporting needs
· Direct oversight and coordination of GeoAccess reports and provider network reports required for submission to the state on an ongoing basis
· Coordinate with Provider Relations and Claims to address Network Data errors and claims processing issues
· Develop reports to assure data integrity among multiple data sources and works with accountable departments to resolve issues
· Responsible for working with the QI department in the development of QI and credentialing reports
· Accountable for any ad hoc reporting needs as defined by the health plan
· May oversee Provider Data department staff and activities including provider set up forms, maintenance of provider records and audit provider data records
Education/Experience: Bachelor's degree in a related area or equivalent experience. 7+ years of experience in a similar position in a health plan or network setting. Project management, claims management/processing, and implementation experience required. Must be able to develop system business requirements.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
More Information About the Job
Is Relocation Available?
Is there a bonus structure?
Are you open to sponsorship?
Is there a possibility to work remote?
Is there equity?
Are there flexible work hours?
Does this position have direct reports?
Who does this position report to?
What are the 3-4 non-negotiable requirements on this position?
Strong operational experience. Healthcare operations management strong analytical skills
What are the nice-to-have skills?
Managed care Provider Data
What is exciting about this opportunity? Please use this section to describe team and company culture.
This division is growing very quickly and we expanding our operations extensively.
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