Manager, Provider Data Quality

Who We Are

Point32Health is a leading health and wellbeing organization, delivering an ever-better personalized health care experience to everyone in our communities. At Point32Health, we are building on the quality, nonprofit heritage of our founding organizations, Tufts Health Plan and Harvard Pilgrim Health Care, where we leverage our experience and expertise to help people find their version of healthier living through a broad range of health plans and tools that make navigating health and wellbeing easier.

We enjoy the important work we do every day in service to our members, partners, colleagues and communities.

Job Summary

The Manager, Provider Data Quality, is responsible for the development and successful oversight of the Point32Health provider directory quality audit program. 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 Point32Health 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

Compensation & Total Rewards Overview

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 modified at the Company’s sole discretion, consistent with the law.

Point32Health offers their Colleagues a competitive and comprehensive total rewards package which currently includes:

• Medical, dental and vision coverage

• Retirement plans

• Paid time off

• Employer-paid life and disability insurance with additional buy-up coverage options

• Tuition program

• Well-being benefits

• Full suite of benefits to support career development, individual & family health, and financial health

For more details on our total rewards programs, visit https://www.point32health.org/careers/benefits/

Commitment to Diversity, Equity, Inclusion, Accessibility (DEIA) and Health Equity

​Point32Health is committed to making diversity, equity, inclusion, accessibility and hea