Manager, Provider Directory Audit

Who We Are Point
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Health is a leading not-for-profit health and well-being organization dedicated to delivering high-quality, affordable healthcare. Serving nearly 2 million members, Point
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Health builds on the legacy of Harvard Pilgrim Health Care and Tufts Health Plan to provide access to care and empower healthier lives for everyone. Our culture revolves around being a community of care and having shared values that guide our behaviors and decisions. We’ve had a long-standing commitment to inclusion and equal healthcare access and outcomes, regardless of background; it’s at the core of who we are.

We value the rich mix of backgrounds, perspectives, and experiences of all of our colleagues, which helps us to provide service with empathy and better understand and meet the needs of the communities where we serve, live, and work.

We enjoy the important work we do every day in service to our members, partners, colleagues and communities. Learn more about who we are  Summary The Manager, Provider Data Quality, is responsible for the development and successful oversight of the Point
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Health provider directory quality audit program, including the oversight of the AI Agent for Directory Audit. This role will be crucial in maintaining the quality and reliability of our provider data, which is essential for our operations and service delivery including the accuracy of the health plan provider directory. The incumbent will lead a team who will be responsible for the directory audit functions, as well as oversight of the attestation vendor platform performance.

This role will require subject matter expertise in providing directory regulations for Medicaid, Medicare, and Commercial products.

Job Description DUTIES/RESPONSIBILITIES – what you will be doing (top five):

Facilitate the development, implementation, of an end-to-end process supporting provider data audits to increase the accuracy of the Point
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Health provider directories.

Design and implement a comprehensive provider directory and data audit program for continuous improvement of provider directory quality.

Establish policies, procedures, and standards for provider data management and audits, and roster reconciliation t.Ensure compliance and stay informed about all relevant regulations and standards related to provider directories.

Responsible for the enterprise provider directory & attestation platform vendor oversight and performance

Establish key performance indicators (KPIs) and metrics to measure the effectiveness of the provider directory and data audit program.

Perform other duties as assigned by management.

QUALIFICATIONS – what you need to perform the job.

EDUCATION, CERTIFICATION AND LICENSURE:

Associates, bachelor’s, or other advanced degree preferred. Equivalent work experience required.

EXPERIENCE (minimum years required):5-7 years’ experience in a managed healthcare organization

Proven experience in program development and team leadership.

Knowledge of Excel and other Microsoft programs to track, update and analyze data.

Strong verbal and written communication skills.

Must be able to work in a high volume, fast paced, goal-orientated environment with quality.

Proven ability to function independently.

SKILL REQUIREMENTS:

Bachelor’s degree in business administration, Healthcare Management, Data Management, or a related field. Master’s degree preferred.

Must possess strong verbal and written communication skills

Advanced understanding and experience with Excel is highly preferred

Salary Range$ -$Compensation & Total Rewards Overview The annual base salary range provided for this position represents a range of salaries for this role and similar roles across the organization. The actual salary for this position will be determined by several factors, including the scope and complexity of the role; the skills, education, training, credentials, and experience of the candidate; as well as internal equity.

As part of our comprehensive total rewards program, colleagues are also eligible for variable pay. Eligibility for any bonus, commission, benefits, or any other form of compensation and benefits remains in the Company's sole discretion and may be…