- Be responsible for accurate and timely contract loading and submissions and interface with matrix partners for network implementation and maintenance.
- Conduct regular audits and analysis of provider data to identify and resolve data discrepancies, duplication, and inaccuracies.
- Develop and implement processes and procedures to ensure data integrity, accuracy, and consistency across multiple systems and databases
- Identify gaps in network composition and services to assist network contracting and development teams
- Continuously evaluate and enhance provider data management processes and workflows to optimize efficiency and accuracy.
- Keep abreast of industry trends, regulations, and technological advancements related to provider data management, and recommend innovative solutions to improve data quality and efficiency.
- Set clear expectations and define accountabilities for the Network Operations team to achieve Vendor-Partner SLAs and internal KPIs
- Develop training materials and provide guidance to staff regarding provider data management processes, tools, and best practices.
- Ensure compliance with regulatory guidelines, such as HIPAA, CMS, and state-specific regulations, regarding provider data management and privacy.
- Work closely with internal stakeholders, including IT, TPA, and Network Development, to address provider data-related issues and facilitate effective network operations.
- Contribute to initiatives for short-term and long-term network operations planning, aligned with network development and company direction.
- Bachelor's degree in healthcare administration, business administration, or a related field OR in lieu of a bachelor's degree, 10+ years of healthcare work experience
- A minimum of 5 years' experience in project management, network operations and/or provider credentialing; with 2 years of management experience preferred.
- Understanding of provider network operations, including data management, credentialing, contract management, and claims processing
- Data-driven decision maker, possessing advanced analytical skills with the ability to succinctly tell the data's story
- An eye for operational excellence with the ability to identify process improvement opportunities and recommend and implement effective solutions.
- Demonstrated ability to work in a fast-paced, evolving environment while managing multiple priorities
- Ability to work collaboratively internally and externally.
- A self-assured, self-directed, and results-oriented attitude
- Flexibility and adaptability to work within a startup environment
- Strong analytical and abstract problem-solving skills.
- A lifelong learner orientation, ability to learn new skills as the organization needs.
- Commitment to the Texicare mission
- A spirit of collaboration and desire to build relationships
- Effective communication skills
- Automatic 4% employer contribution to retirement plan
- 401k plan with 100% match up to 6%
- Flexible time off for vacation, illness, etc.
- Nine paid holidays
- Day one health, Rx, vision, and dental insurance
- Life and disability insurance
- Flexible spending account
- Pet coverage and pet Rx discounts
- Free identity theft protection
- Free 2nd medical opinion service
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Manager of Network Operations - Texas, United States - Texicare
1 week ago
Description
As the leading provider of workers' compensation in the state, Texas Mutual is trusted by businesses, many of which are small businesses. Texicare, Texas Mutual's new health care subsidiary, is dedicated to transforming the limited options available to small Texas businesses and their employees. We're looking for passionate, committed individuals who share our vision and are ready to join us as we lay the foundation for an important improvement in health care coverage.
As a member of the Network Development leadership team, the Manager of Network Operations will participate in the successful implementation of provider data management tools at Texicare. You will oversee the integrity and quality of provider data, ensuring compliance with industry regulations and collaboration with various departments to enhance network operations. The ideal candidate should be highly organized and possess excellent analytical skills, have strong attention to detail and a thorough understanding of provider data management from a payer perspective.
In this role, you will:
To be successful in this role, you should have:
Benefits:
Texicare is an equal opportunity employer.
