Manager PIM Provider Maintenance

Job ID: J122359
Company: Gateway Health Plan
Location: Pittsburgh, PA, United States
Full/Part Time: Full time
Job Type: Regular
Posted at: May 11, 2018

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Description

JOB SUMMARY


This job directs and manages the activities for the department.  Responsible for the effective and efficient management of all activities, departmental applications and systems supporting corporate provider enrollment and demographic provider data maintenance.  The incumbent is accountable for the leadership of key corporate operational provider data administration, management and reporting functions.  Oversees responses to provider audits related to provider enrollment data warehousing, maintenance and reporting. Coordinates division projects, oversee business analyst for project management and provider department/corporate projects with oversight and provide subject matter expert support.  
  
ESSENTIAL RESPONSIBILITIES  

  • Ongoing maintenance and integrity of provider file and all sub-files and extract files.  
  • Perform administrative and personnel activities.  
  • Develop strategic and operational plans for department.
  • Implement effective quality control procedures and management reports, measure end improve processes on a routine/ongoing basis.
  • Support corporate initiatives, system changes to the provider file, transitions and other changes for the business unit.
  • Coordinate, participate and communicate divisional projects with Analyst support to management.
  • Communicate and coordinate essential activities with Provider Relations, Contracting, Compliance and external customers.
  • Other duties as assigned or requested.

QUALIFICATIONS


Minimum

  • High School diploma or equivalent
  • 3 years of experience  personnel management
  • 3 years of provider data management and operations experience  

Preferred

  • Bachelor’s degree
  • Experience in basic contracting and credentialing
  • Claims Experience
  • Healthcare Experience

Skills  

  • Experience leading or managing projects and related activities
  • Analytical orientation, expert problems solving aptitude
  • Healthcare compliance, CMS Regulations, NCQA, DOH, DOI, BCBSA experience


 

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
EEO is The Law
Equal Opportunity Employer Minorities/Women/ProtectedVeterans/Disabled/Sexual Orientation/Gender Identity (http://www1.eeoc.gov/employers/upload/eeoc_self_print_poster.pdf)
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