Manager, Provider Data Management - Phoenix, AZ

Unitedhealth Group Inc. Phoenix , AZ 85002

Posted 7 days ago

The Provider Data Management (PDM) Manager is responsible for the overall direction and management of provider data and analytics across multiple OptumCare local care delivery organizations. The PDM manger is responsible for all programs, along with training and developing department staff. The manager is responsible for directing key improvement activities for PDM, which include process improvement, business rules management, creating efficiencies and streamlining functions, as well as leading cross functional groups in the development and implementation of system improvements. This position works collaboratively with key constituents across the organization and with external provider partners, including health networks and physicians.

Primary Responsibilities:

  • Determine and / or communicate impacts of proposed changes to internal and/or external business partners (e.g., internal departments, providers)

  • Perform data queries on relevant systems in order to obtain claims information

  • Review provider contracts in order to ensure information submitted is accurate and consistent with loading guidelines

  • Communicate identified discrepancies back to contract submitter in order to facilitate corrections of discrepancies

  • Interpret and/or verify contract language, information, and intent in order to load information into systems properly

  • Perform audits of new and / or existing provider contracts and fee schedules in order to ensure accuracy

  • Research potential and / or existing providers by reviewing market rules, existing contracts, and/or provider specialty

  • Load contract information or implement updates and amendments (e.g., fee schedule updates, new fee schedules, demographic

  • changes, termination, rate corrections) accurately into appropriate systems (e.g., NDB, COSMOS, FACETS and NICE,)

  • Review and/or maintain reports (e.g., metrics, dashboards, spreadsheets) associated with provider contract loading (e.g. Turnaround time, number of contracts loaded, accuracy) in order to assess performance, determine potential issues, and/or prioritize workloads (e.g., submissions to be addressed first)

  • Receive and respond to escalated issues and problems involving contract submissions

  • Interpret existing contracts in order to identify potential problems or issues needing correction

  • Collaborate with relevant internal and / or external partners (e.g., IT, Health Plan, local Care Delivery Organizations, sub delegated vendors and providers) to ensure that data is timely and accurate

  • Identify and / or implement potential long-term, permanent solutions to resolve recurring issues and problems (e.g., training, process changes)

  • Conduct testing of proposed solutions and/or changes made in order to determine their effectiveness and make necessary modifications

Required Qualifications:

  • Bachelor's degree in Health Services, Business Administration, or related field; or equivalent combination of education and work experience in the health care industry is required

  • 3 years provider data management experience

  • 5 years of experience in leadership / management role

  • 2 years healthcare data analytics experience

  • Proven ability to lead a team with varying levels of technical and business abilities to ensure effective use of individual skills to achieve team goals and objectives

  • Proven ability to effectively communicate complex information to audiences with varying backgrounds in a variety of formal and informal settings

  • Ability to develop and maintain effective and productive working relationships with all levels of staff

  • Work under internal and external time and operational constraints

  • Evaluate departmental business needs and make swift and effective decisions based on available resources

  • Experience creating and monitoring performance scorecards and / or performance metrics

  • Experience analyzing and compiling large swaths of data and present effective reports

  • Excellent communication skills, a positive attitude and a go-getter drive

Preferred Qualifications:

  • Bachelor's degree

  • Medicare & Medicaid experience

  • Operational healthcare experience

  • Consulting experience

  • Experience influencing others without direct authority

  • Business minded and strategic planner with impeccable time management and multi-tasking skills

  • Experience leading process improvement initiatives

Strong Knowledge:

  • Provider contracting and customer service techniques

  • Managed care Practice Management systems and data integrity

  • Problem solving, time management and organizational techniques

  • Health network operations core infrastructure, the depth and capacity of the provider network, understanding of the network's boilerplate contract languages and various payment arrangements, and knowledge of the health network's membership profile

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)

Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment

Job Keywords: Manager, Data, Healthcare, Phoenix, Arizona, AZ


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Manager, Provider Data Management - Phoenix, AZ

Unitedhealth Group Inc.