Data Governance & Ownership Sr. Manager - Medicare Provider Data Quality & Accuracy

Summary

The Data Governance & Ownership (DG&O) Senior Manager will work with the Provider Data Quality & Accuracy (PDQA) Director to establish the framework and policies to drive improvements in the provider data domain to ensure we meet specific goals and metrics, as defined by business and regulatory requirements.

They will lead a team of data stewards responsible for maintaining data lineage, business rules requirements and documentation and usage of each element, covering the following domains:

• Credentialing

• Directory

• Reimbursement\Capitation

• Configuration

• Network

Essential Functions and Responsibilities

• Coordinate and partner with the key Medicare operations teams, including claims, enrollment, fulfillment, network operations, and technology, to ensure delivery of operational excellence.

• Monitoring of provider data quality and accuracy leading to CMS compliant provider directories and improved claims auto-adjudication.

• Work within the Data Quality management process to champion incremental improvements and deployments that result in measurable improvements in data quality, understanding the business impacts and prioritizing the data quality remediation.

• Partner with product/process owners to create and implement data governance frameworks, policies, and standards to ensure data quality and compliance and to eliminate non-value added effort, by reducing unnecessary data entry, sharing data across systems, and other methods.

• Ensure the data stewards are effectively managing assets.

• Support the development of and oversee quality metrics and monitoring processes to ensure data integrity and accuracy.  Implement data cleansing and validation procedures.

• Identify and mitigate data-related risks.  Monitor controls to safeguard data assets and ensure their proper usage.

• Establish and track KPIs to measure the effectiveness of data governance initiatives.  Provide regular reports to senior management on data governance activities and progress.

• Attract, recruit, hire, develop, mentor, coach and retain top talent to enable execution of the Medicare growth strategy.

Qualifications

Candidates should model our team’s core values – Communicate Effectively and Instills Trust.  As a people manager they should also model Manages Ambiguity and Drives Results. They should also have the following skillset and characteristics.

Preferred Qualifications:

• Bachelor’s degree

• At least 5 years of relevant experience, i.e. data governance, data management.

• Strong preference given to individuals experienced in healthcare and working with provider data management.

• Candidates should have demonstrated experience leading and developing teams.

• Must be proficient in SQL and experience mentoring others in developing this skillset.

• Proficiency in data governance tools and technologies is a plus.

• Certification in data management (e.g. CDMP, DGSP) is a plus.

• Strong analytical, synthesizing, & problem-solving skills with emphasis on utilizing business processes & technology to solve business problems. 

• Demonstrated ability to work at both conceptual & detailed levels.

• Willingness to share opinions and take risks.

• Experience with client facing business units preferred.

• Creative thinker with ability to think outside the box & translate strategies into actions. 

• Must possess strong organizational skills with ability to manage multiple priorities simultaneously.

• Strong, clear, concise, and analytical written and oral communication skills.

Direct reports

This position will have multiple direct reports.

If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.

For this position, we anticipate offering an annual salary of 127,400 - 212,300 USD / yearly, depending on relevant factors, including experience and geographic location.

This role is also anticipated to be eligible to participate in an annual bonus plan.

We want you to be healthy, balanced, and feel secure. That’s why you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and