Director Provider Data Management

This position is a Hybrid position with the option for either full-time in office or hybrid between remote/home and in office as required. It will require periodic meetings in the main office in Seattle. Any candidate located within Washington State is welcome to apply.

Who we are

Community Health Plan of Washington is an equal opportunity employer committed to a diverse and inclusive workforce. All qualified applicants will receive consideration for employment without regard to any actual or perceived protected characteristic or other unlawful consideration.

Our commitment is to:

• Strive to apply an equity lens to all our work. 
• Reduce health disparities. 
• Become an anti-racist organization. 
• Create an equitable work environment. 

About the Role

The Director of Provider Data Management owns and is responsible for CHPW’s Provider Data Management Program, directing internal processes related to managing Provider Data Services; responsible for interpreting, analyzing, researching and maintaining accuracy and completeness of provider data across multiple data bases and online provider directory. Oversight of the setup and maintenance of provider demographics, provider exclusions by regulatory authorities, provider terminations (voluntary and involuntary) in claims system and working directly with providers and internal departments to resolve escalated concerns.

To be successful in this role, you:

·       Have ten or more (10+) years’ experience within healthcare operations, operational quality improvement.

·       Have six or more (6+) years’ experience successfully managing and mentoring people leaders and direct reports required.

·       Have experience with contract negotiations and oversight of business process vendors.

·       Have five (5) years’ experience handling progressively more complex healthcare issues strongly required.

·       Have experience managing projects across departments and work groups.

·       Have experience with state and federal managed care preferred.

·       Have experience establishing and managing complex relationships strongly preferred.

·       Have experience with advanced analytic features of Access and Excel preferred.

Essential functions and Roles and Responsibilities:

·       Identify, lead, and contribute to short- and long-term organizational planning and strategy as a member of the leadership team. Represent provider data and Provider Data Services department on key cross-departmental and companywide projects, improvement teams, and organizational initiatives, CHPW’s Strategic Planning, and bringing on new products.

·       Responsible for directing PDS staff including identifying staffing and resource needs, build and manage highly effective teams with effective hiring, appropriate performance management to achieve department goals, staff development to achieve long-term operational excellence within Provider Data Services department.

·       Provide direction and manage key vendor relationships for provider data, configuration, enhancement development, quality assurance, and provider directory with NTT, Vision Services Plan and Washington Health Benefit Exchange (WAHBE), and others as needed. Partners with DHP/NTT for creation and administration of online provider data and provider and member portals (HealthMAPS, myCHPW).

·       Partner with Director, BPO to manage provider data maintenance vendor service level agreements.

·       Oversee budget requirements. Manage within approved budgets and request exceptions as needed.

·       Partners with Director, Business Process Operations (BPO) to direct prioritization of system configuration, testing and implementation activities involving provider data.

·       Create, maintain and project manage business/user requirements; user testing acceptance, peer review/approval, post-production monitoring and communication of provider data projects.

·       Establish standard process to monitor and report program performance, working across technical and departmental units to define business requirements necessary to support program performance measurement and evaluation activities.

·       Respond to State and Centers for Medicare and Medicaid Services (CMS) requirements for provider data quality assurance; TEAMonitor, Health Effectiveness Data and Information Set (HEDIS), National Committee for Quality Assurance (NCQA), all CMS audits (program audits, data validation, finance, and claims audits), and Washington state Office of the Insurance Commissioner (OIC). 

·       Responsible for provider data results for annual Internal