Interested in a career with both meaning and growth? Whether your abilities are in direct patient care or one of the many other areas of healthcare administration and support, everyone at Parkland works together to fulfill our mission: the health and well-being of individuals and communities entrusted to our care. By joining Parkland, you become part of a diverse healthcare legacy that’s served our community for more than 125 years. Put your skills to work with us, seek opportunities to learn and join a talented team where patient care is more than a job. It’s our passion.

 

Primary Purpose

Parkland Community Health Plan’s (PCHP’s) Manager of Provider Data Management leads the strategic and operational management of provider data. Ensures the accuracy and integrity of provider data, monitors regulatory compliance, and enhances data driven decision making. Optimizes provider data for use throughout the organization.

 

Minimum Specifications

 

Education

Bachelor’s degree in business administration, healthcare management, or a related field.

 

Experience

5 years of Provider Data Management. 5 years of leadership experience. 4 years leading Provider Data Management teams at managed care organization. Deep knowledge of Provider data within systems and vendors such as Symplr, CAQH, HiLabs, Availity.

 

Equivalent Education and/or Experience

May have an equivalent combination of education and/or experience in lieu of specific education and/or experience.

 

Certification/Registration/Licensure

Project management or Six Sigma certification preferred.

 

Skills or Special Abilities

Experience with provider data management in QXNT is imperative to this position. Experience defining and validating business requirements, including ability to translate configuration to business rules and vice versa. Knowledge of XML and SQL. Excellent verbal and written communication skills including the ability to communicate effectively and professionally across disciplines and with a variety of constituents as well as the ability to articulate complex information in understandable terms. Demonstrated ability to coach and influence for results. Strong interpersonal and conflict resolution skills with the ability to establish and maintain effective working relationships with diverse groups across and beyond the organization. Strategic thinking and long-range planning skills with the ability to lead major organizational initiatives, accomplish results, and achieve measurable outcomes or goals. Ability to work in challenging situations involving competing interests, and high level-interdisciplinary groups. Excellent time management and organizational skills with the ability to manage multiple demands and respond to rapidly changing priorities. Strong analytical and problem-solving skills. Knowledge of Texas Medicaid (STAR, STAR Kids/CHIP) program, National Committee for Quality Assurance (NCQA), the Uniformed Managed Care Contract, and the Uniform Managed Care Manual. Sound business acumen. Proficient Microsoft Office and computer skills.

 

Responsibilities

Leadership

Develop and monitor KPIs to assess the effectiveness of provider data management initiatives. Initiate, develop, implement, optimize, and oversee provider data processes for the successful processing and verification of information during the provider credentialing and recredentialing process. Develop, maintain, and continuously improve processes for prioritizing requests for changes and additions to provider data. Ensures these requests are managed efficiently from initiation through to successful publication or updates in sources of truth. Develop and maintain department policies and procedures governing provider data.

Operations

Manage provider files and delegated entity provider rosters for configuration into QXNT system. Manage development and implementation of provider data interfaces, solutions and auditable monitoring processes that include control and balance, exception handling, tracking, trending, and reporting. Management of provider data by overseeing and/or conducting regular audits to ensure the accuracy and integrity of provider information in system databases and systems and implement data quality initiatives, automate data entry processes, and resolve data discrepancies efficiently.

Quality

Ensure quality related to provider data management. Integrate health literacy principles into all communication including Members and Providers. Support strategies that meet clinical, quality and network improvement goals. Promote the use of Health Information Technology to support and monitor the effectiveness of health and social interventions and make data-driven recommendations as needed. For staff in clinical roles, foster collaborative relationships with members and/or providers to promote and support evidence-based practices and care coordination.

Regulatory

Ensure that all provider data management practices comply with federal, state and industry regulations, including Medicaid (Texas), ACA, HIPAA, and CMS. Develop and monitor processes to maintain compliance with regulatory agencies and accrediting bodies. Ensures operations are carried out in compliance with these regulations. Works collaboratively with others to validate and sustain compliance with regulatory and accreditation standards. Conducts routine compliance audits identifying gaps and implementing remediation plans as necessary. Works collaboratively with leadership and/or PCHP Compliance to investigate and respond to matters of concern or alleged violations taking corrective action as necessary. Provides timely and accurate responses to requests for information from regulatory agencies and accrediting bodies. Fiscal Management and Operating Budget Operationally responsible for the financial performance of assigned area(s). Promote activities to achieve operational efficiency. Manage the approved budget through frequent and regular monitoring. Implement written action plans to address variances adjusting strategies as necessary to meet budgetary targets. Consider operational outcomes and financial implications when making recommendations to implement new programs or modify current programs. Manage staffing levels within established targets.

Talent Management

Recruit and retain diverse talent with a variety of backgrounds, skills, experiences, and viewpoints that reflect the communities we serve. Promote and support a culturally welcoming, inclusive, collaborative, and highly engaged work environment where everyone feels empowered to bring their full, authentic selves to work. Accountable for orientation, ongoing education and training, and competency verification for all employees. Ensure Human Resource metrics (i.e., retention, vacancy, engagement) meet established targets. Utilize workforce metrics to monitor, identify, and respond to workforce trends. Timely completion of employee performance appraisals. Conduct regular meetings, inform team of changes in policy or procedure, and provide information regarding overall strategy and direction of the health plan. Mentor, coach, and support direct reports with building teamwork, professional development, and education to achieve optimal performance and develop talent. Ensure employee engagement survey participation rates and results meet established targets. Mandatory requirements are completed timely by employees. Required licensure, certification, and/or registry are current and in good standing for all employees. Employee performance is monitored and managed. Consult with the Office of Talent Management as appropriate regarding employee performance concerns and disciplinary action.

Professional Accountability

Work collaboratively with internal and external stakeholders, regulators, and auditors. Acts with the highest integrity and ethical standards while adhering to Parkland's Mission, Vision, and Values. Adheres to organizational policies, procedures, and guidelines. Completes assigned training, self-appraisal, and annual health requirements timely. Adheres to hybrid work schedule requirements. Attends required meetings and town halls. Recognizes and communicate ethical and legal concerns through the established channels of communication. Demonstrates accountability and responsibility by independently completing work, including projects and assignments on time, and providing timely responses to requests for information. Maintains confidentiality at all times. Performs other work as requested that is reasonably related to the employee’s position, qualifications, and competencies.

 

Job Accountabilities

Identifies and analyzes the design of jobs, work processes, workflows, etc. for the area and implements appropriate changes to improve effectiveness, productivity, and efficiency that support the overall goals of PCHP. Stays abreast of the latest developments, advancements, and trends in the field by attending seminars/workshops, reading professional journals, actively participating in professional organizations, and/or maintaining certification or licensure. Integrates knowledge gained into current work practices. Maintains knowledge of applicable rules, regulations, policies, laws, and guidelines that impact the area. Develops effective internal controls designed to promote adherence with applicable laws, accreditation agency requirements, and customer requirements. Seeks advice and guidance as needed to ensure proper understanding. Develops and monitors annual budgets that ensure the department has the necessary funds to carry out the goals and objectives that have been established for the department. Develops, implements, monitors, and revises annual goals and objectives for the department that support the missions and objectives of PCHP. Selects, trains, schedules, motivates, supervises, and evaluates employees making recommendations for disciplinary actions up to and including termination, to ensure maximum utilization of individual and group capabilities. Ensures that assigned employees receive opportunities to further their knowledge.

 

Parkland Health and Hospital System prohibits discrimination based on age (40 or over), race, color, religion, sex (including pregnancy), sexual orientation, gender identity, gender expression, genetic information, disability, national origin, marital status, political belief, or veteran status. As part of our commitment to our patients and employees’ wellness, Parkland Health is a tobacco and smoke-free campus.