Senior Manager, Provider Data Operations Implementation

Job Summary:

The Senior Manager, Provider Data Operations Implementation is responsible for supporting company’s growth initiatives by planning and overseeing the execution of provider data management projects, with a particular focus on the integration and ingestion of new provider data into company’s provider data management system. This role ensures that all provider data set up and associated maintenance processes are delivered on schedule and in compliance with regulatory standards, while driving process improvement and operational efficiencies.

Essential Functions:

• Plan and manage integration of provider data by implementing solutions that effectively process provider data through credentialing, contract administration and load into core provider data management system. Ensure needs of downstream systems and processes extracts to delegation vendors, claims systems, prior authorization system and customer service system are met.
• Lead and manage the end-to-end implementation process for provider data initiatives, including new provider data integrations, development of data interfaces, and process enhancements. Develop project timelines, ensure resources are allocated appropriately, and track project progress to ensure on-time delivery.
• Oversee the collection, validation, and processing of provider data across various systems. Ensure accuracy, consistency, and completeness of provider information in the MCO's data repository. Manage the integration of provider data from various sources, such as enrollment systems, claims systems, and external third-party data vendors.
• Supervise and mentor a team of data operations professionals, providing guidance, training, and performance management to optimize productivity and foster professional development. Foster a collaborative team culture and support employees in achieving individual and team goals.
• Act as the primary liaison between cross-functional teams to ensure that provider data needs are met. Collaborate with external vendors and healthcare providers as necessary to resolve issues and ensure smooth implementation. Prepare and present status updates to executive leadership.
• Analyze and evaluate current processes and workflows for provider data implementation, identifying opportunities for automation, efficiency gains, and operational improvements.
• Ensure that all provider data processes comply with relevant healthcare regulations, such as HIPAA, CMS guidelines, and state-specific requirements. Develop and enforce quality assurance protocols to ensure the integrity and accuracy of provider data throughout the implementation process.
• Develop and present regular reports on implementation progress, key performance metrics, and outcomes to senior leadership. Provide insights and recommendations for ongoing improvements based on data analysis.
• Perform any other job duties as requested

Education and Experience:

• Bachelor’s degree in Computer Science, Healthcare Administration, Business Administration, a related field, or equivalent years of relevant work experience is required
• Seven (7) years of experience in healthcare data operations, with at least three (3) years in a leadership or management role, is required
• Experience in managing large-scale data integration projects, preferably within a managed care or insurance organization is required

Competencies, Knowledge and Skills:

• In-depth knowledge of healthcare provider data structures, including credentialing, contracting, and claims data management. Understanding of relevant regulations (e.g., HIPAA, CMS guidelines) and industry standards
• Track record of managing cross-functional teams and collaborating with stakeholders from diverse departments (e.g., IT, provider relations, claims)
• Strong knowledge of provider data management, system implementations, and regulatory compliance
• Strong ability to lead, inspire, and develop high-performing teams. Excellent interpersonal and communication skills to motivate staff, manage performance, and drive collaboration across departments
• Expertise in project planning, risk management, and execution. Experience with project management tools (e.g., MS Project, Azure DevOps) and agile methodology
• Ability to identify issues, analyze root causes, and develop effective solutions. Strong decision-making and troubleshooting skills to resolve complex implementation challenges.
• Strong written and verbal communication skills, with the ability to present complex data in an easily understandable manner to senior leadership and external partners. Ability to communicate with both technical and non-technical stakeholders.
• Ability to analyze data trends, assess implementation outcomes, and derive actionable insights for process improvement
• Skilled in navigating organizational change and supporting teams through transitions
• Proficiency in Microsoft Office Suite (Excel, Word, PowerPoint)

Licensure and Certification:

• None

Working Conditions:

• General office environment; may be required to sit or stand for extended periods of time
• Occasional travel may be required

Compensation Range:

CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type (hourly/salary):

Organization Level Competencies

• Create an Inclusive Environment

• Cultivate Partnerships

• Develop Self and Others

• Drive Execution

• Influence Others

• Pursue Personal Excellence

• Understand the Business

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an inclusive environment that welcomes and supports individuals of all backgrounds.