Career Opportunities: Provider Data Supervisor (24830)

Candidates hired for remote positions must reside in Oregon, Washington, Utah, Idaho, Arizona, Nevada, Texas, Montana, or Wisconsin.

Job Summary

This position is responsible for leading the daily operations of the provider data team in support of organizational needs and in compliance with state and federal requirements. Primary responsibilities include technical supervision, planning, communications, people leadership and technical assistance.

Essential Responsibilities

Technical Supervision

• Supervise daily operations of provider data activities.
• Provide reporting on current inventory and provide strategies for managing inventory to meet operational SLAs.
• Assist in the development of new reporting to help the department track productivity and quality metrics.
• Incorporate best practices for the business unit.
• Coordinate all activities related to the planning, implementation, and operation of QNXT as it relates to provider data.
• Oversee provider database maintenance activities, including data entry, process administration, queue monitoring, quality customer service and problem resolution.
• Develop and monitor effective processes to ensure provider database integrity and accuracy.
• Coordinate data integrity projects, working with internal customers and assigning staff as needed to make updates to QNXT provider file and workflows in support of data submission to regulatory bodies and provider directories.
• Guide staff in provider data reporting for internal business partners and regulatory entities.
• Monitor and track team metrics through the creation of monthly quality and productivity reports. 
• Coordinate the compilation and submission of state and federal required provider data reporting such as OHA DSN capacity report and CMS Network Adequacy.
• Lead in the development and implementation of provider data policies and procedures.
• Create and oversee the maintenance of detailed standard operating procedures for all essential functions of the position.

Planning

• Approve staff scheduling and work assignments and coordinate coverage during times of absences and increased workload.
• Create and manage a schedule of required reporting, develop project plans that efficiently monitor supporting activities to ensure compliance with reporting deadlines.
• Manage resources to ensure work and project success.
• Provide input into long-term planning and appropriate levels of staffing
• Provide functional unit with ongoing understanding of the strategic and operational direction of CareOregon.

Communications

• Establish and maintain cooperative and productive working relationships with internal and external customers.
• Coordinate the provider data team’s communication with external customers regarding provider information, provider status, claims administration as it relates to provider set-up, and responses to changes in the business or regulatory environment.
• Coordinate the provider data team’s communication with internal and external customers as it relates to provider data and responses to changes in the business or regulatory environment.
• Serve as key internal contact on QNXT provider systems issues, upgrades, and emergent business needs; coordinate changes in work practices and procedures with provider configuration staff and ensure documentation accurately reflects current work environment.
• Coordinate responses to internal and external (e.g., OHA, CMS, etc.) audits.
• Represent provider data team on Network Adequacy Steering Committee and identify issues; make recommendations about provider network capacity and adequacy in each CareOregon service area.
• Participate in leadership of QUsers Group Provider Data Workgroup.

Technical Assistance

• Serve as QNXT provider data subject matter expert with internal customers including, but not limited to, Network & Clinical Support, QI/Credentialing, and IS/Development.
• As escalated, audit provider database and online provider directory to ensure compliance with written documentation.
• As needed, perform technical work with staff, including the following:
  • Research internal and external data sets, validate data and determine the correct course of action in case of data discrepancy/anomalies
  • Conduct analyses of provider-related new and existing products and business units.
  • Create, research, and send reports
  • Perform analyses and identify database solutions using tools such as Excel and SQL
  • Communicate with internal partners to document data requirements and transform into specifications for development
  • Consult with Provider Services, Operations leadership, users, stakeholders, and external vendors to define and document business requirements for reporting provider data
  • Ensure maintenance of documented variable criteria and logic used to produce provider data reporting, including the provider directory

Employee Supervision

• Supervise team and recommend team direction and goals in alignment with the organizational mission, vision, and values.
• Identify work and staffing needs to meet work expectations; recruit and hire, using an equity, diversity and inclusion lens.
• Plan, organize, schedule, and monitor work; ensure employees have information and resources to meet job expectations.
• Lead the development, communication, and oversight of team and individual goals; ensure goals, expectations, and standards are clearly understood by staff.
• Train, supervise, motivate and coach employees; provide support toward employee development.
• Incorporate guidance from CareOregon equity tools into people leadership, planning, operations, evaluation and decision making.
• Ensure team adheres to department and organizational standards, policies and procedures.
• Evaluate employee performance and provide regular feedback to support success; recognize strong performance and address performance gaps and accountability (corrective action). 
• Perform supervisory tasks in collaboration with Human Resources as needed.

Organizational Responsibilities

• Perform work in alignment with the organization’s mission, vision and values.
• Support the organization’s commitment to equity, diversity and inclusion by fostering a culture of open mindedness, cultural awareness, compassion and respect for all individuals.
• Strive to meet annual business goals in support of the organization’s strategic goals.
• Adhere to the organization’s policies, procedures and other relevant compliance needs.
• Perform other duties as needed.

Experience and/or Education

Required

• Minimum 4 years' experience with provider data management in a managed care or insurance environment, including experience leading projects

Preferred

• Minimum 1 year experience in a supervisory or lead position or completion of CareOregon’s Aspiring Leaders Program; lead roles preferably include regular assistance to a manager or supervisor in staff hiring, coaching, performance evaluation, and other supervisory tasks

Knowledge, Skills and Abilities Required

Knowledge

• Excellent knowledge of relational databases
• Excellent understanding of managed care, Medicare, and Oregon Health Plan concepts
• Understanding of database construction
• Knowledge of computer programming concepts and practices
• Knowledge of GeoAccess Reporting preferred

Skills and Abilities

• Strong analytical and research skills; able to see patterns in data and draw logical conclusions

• Ability to interpret contract language
• Advanced skills in claims processing technologies, such as QNXT and Facets
• Advanced skills in document management and collaboration platforms such as SharePoint
• Advanced skills with Microsoft products, including Access, PowerPoint, Excel, Word, and Outlook
• Ability to participate in the development and monitoring of policies and procedures
• Advanced skills in troubleshooting data integrity issues and root cause
• Excellent communication skills and presentation skills
• Ability to clearly articulate policies, instructions, goals, and objectives
• Expert ability to author and maintain process documentation
• Ability to convey appropriate level of detail to all levels of the organization including non-technical staff and senior leadership
• Ability to effectively collaborate with coworkers, staff, and leaders across all departments
• Excellent ability to network and use internal and external resources
• Leadership skills, including the ability to train, coach and supervise staff
• Ability to effectively delegate and coordinate tasks for multiple people and projects
• Advanced ability to handle multiple and competing priorities and requests
• Project management skills and ability to meet deadlines
• Ability to proactively work to build and improve the department
• Able to develop and implement solutions and communicate business value
• Possess a high degree of initiative, motivation, and professionalism
• Ability to maintain a positive attitude

• Ability to work effectively with diverse individuals and groups

• Ability to learn, focus, understand and evaluate information and determine appropriate actions
• Ability to accept direction and feedback, as well as tolerate and manage stress
• Ability to see, read, and perform repetitive finger and wrist movement for at least 6 hours/day
• Ability to hear and speak clearly for at least 3-6 hours/day

Working Conditions

Work Environment(s):  ☒ Indoor/Office     ☐ Community       ☐ Facilities/Security      ☐ Outdoor Exposure

Member/Patient Facing:    ☒ No                        ☐ Telephonic        ☐ In Person 

         Hazards:  May include, but not limited to, physical and ergonomic hazards.

Equipment:  General office equipment

Travel:  May include occasional required or optional travel outside of the workplace; the employee’s personal vehicle, local transit or other means of transportation may be used.

#MULTI

Candidates of color are strongly encouraged to apply. CareOregon is committed to building a linguistically and culturally diverse and inclusive work environment.

Veterans are strongly encouraged to apply.

We are an equal opportunity employer. CareOregon considers all candidates regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, or veteran status.

Visa sponsorship is not available at this time.