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Senior Manager, Provider Data Management and Cred Resume Example

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SENIOR MANAGER, PROVIDER DATA MANAGEMENT AND CRED
Professional Summary

Talented Senior Manager highly effective at facilitating communication between different areas to maximize team and business success. Focused on continuous business and professional improvement. Excellent process improvement, problem resolution and conflict resolution abilities.

Skills
  • Cross-functional Team Leadership
  • Employee Development
  • Effective Communicator
  • Process Implementation
  • Conflict Management
  • Problem Resolution
  • Staff development
Work History
Senior Manager, Provider Data Management and CredCompany Name - City, State07/2017 - Current
  • Oversee 20-23 staff within separate teams.
  • Identify and implement value-added programs and initiatives that support and enhance network contracting to achieve operational efficiency.
  • Facilitate and assist with problem resolution for internal provider network management issues but also for broader scope issues that impact provider network management including, but not limited to providers, claims, customer contact center, medical management, and appeals and grievances.
  • Maintain departmental policies and procedures to ensure provider data functions follow State Medicaid, Medicare and Marketplace provider enrollment and termination requirements.
  • Assist and guide top-tier provider groups with escalated issues to resolve and prevent potential claims payment errors Collaborate with internal departments to identify project requirements and ensure satisfactory project completion.
  • Develop relationships with other departments and health plans to ensure provider enrollment activities are linked appropriately to other applicable areas within the organization.
  • Perform management duties including budgeting, performance management, staff development, training, staffing, and establishing department goals and objectives.
  • Manage and validate provider updates to ensure data transfers from the internal database to the online directory enhancing customer satisfaction.
  • Serve as the main contact for internal departments on projects that require changes to business applications - provider, contracts and claims.
  • Participate in forums focused on improving Employee Engagement.
  • Assisted with NCQA requirements for credentialing certification.
  • Maintain provider integrity guidelines for delegated credentialing vendors Prioritize data analysis projects based on business needs.
  • Perform ad-hoc reporting as necessary to meet strategic and operational requirements.
  • Manager, provider data management and credentialing.
  • Managed large-scale projects and initiatives including, introducing new systems, tools, and processes to support attainment of challenging objectives.
  • Managed inventory, production, workflow and distribution, analyzing each stage of product life cycle and recommending improvements to streamline processes.
Manager, Provider Data Management and CredentialinCompany Name - City, State05/2014 - 07/2017
  • Supervised 12-15 staff within separate teams.
  • Managed activities that support all provider data management and credentialing projects, policies and procedures, provider contract set up activities, key initiatives that related to operational issues for provider data maintenance that support successful claims adjudication, as well as other operation projects that support internal departments and other health plans.
  • Implemented a process of enrolling large amounts of provider data via a batch load function to increase production and efficiency
  • Verified providers were loaded accurately into the newly contracted Medicare Advantage and D-SNP networks contracted by Network Development
  • Monitored team performance to ensure established and provider data quality benchmarks are met.
  • Collaborated with various departments on complex and elevated provider data issues to implement solutions and identify process improvements.
  • Oversaw the development of reports to support strategic and operational requirements of the departments.
  • Monitored the maintenance of all delegated entity arrangements.
  • Attended quarterly corporation summits focusing on the accuracy of the online provider directory.
  • Conducted training for both internal and external departments surrounding provider data services requirements and processes supervisor, provider data management and credentialing.
  • Reviewed performance data to monitor and measure productivity, goal progress and activity levels.
  • Cross-trained existing employees to maximize team agility and performance.
  • Evaluated employees' strengths and assigned tasks based upon experience and training.
Supervisor, Provider Data Management and CredentiaCompany Name - City, State10/2010 - 05/2014
  • Supervised 4-6 staff within separate teams.
  • Managed the daily operations of all provider data management and credentialing functions Served as the Subject Matter Expert of the implementation of the Portico provider database utilized for credentialing and provider enrollment functions.
  • Direct provider data management related activities based on plan and contract specifications and standard business rules – includes data analysis and entry, review of data via internet sites and other systems, usage of multiple systems and applications to validate data is complete and accurate, and investigation and resolution of data issues.
  • Assisted with the development of a user-friendly tool within the Portico database resulting in a more efficient enrollment process.
  • Confirmed providers were successfully loaded to the additional Medicaid program awarded to the health plan.
  • Adjusted job assignments and schedules to keep pace with dynamic business needs, factoring in processes, employee knowledge and customer demands.
  • Applied strong leadership talents and problem-solving skills to maintain team efficiency and organize workflows to meet any daily demand.
  • Monitored employee performance and provided coaching and constructive guidance to address areas of concern.
Education
MBA: Business AdministrationIndiana Wesleyan University - City, State12/2012
Bachelor of Science: Business AdministrationIndiana Wesleyan University - City, State08/2010
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Resume Overview

School Attended

  • Indiana Wesleyan University

Job Titles Held:

  • Senior Manager, Provider Data Management and Cred
  • Manager, Provider Data Management and Credentialin
  • Supervisor, Provider Data Management and Credentia

Degrees

  • MBA : Business Administration
    Bachelor of Science : Business Administration