Provider Data Manager
Company: Fallon Health
Posted on: November 26, 2022
About Fallon Health:
Fallon Health is a company that cares. We prioritize our
members-always-making sure they get the care they need and deserve.
Founded in 1977 in Worcester, Massachusetts, Fallon delivers
equitable, high-quality coordinated care and is continually rated
among the nation's top health plans for member experience, service,
and clinical quality. Today, guided by our mission of improving
health and inspiring hope, we strive to be the leading provider of
government-sponsored health insurance programs-including Medicare,
Medicaid, and PACE (Program of All-Inclusive Care for the Elderly)-
in the region. Learn more at fallonhealth.org or follow us on
Facebook, Twitter, and LinkedIn.
Brief Summary of Purpose:
Manage Provider Data Management team. Develop and build successful
procedures to conduct provider outreach, data validation and
updates into Core Record keeping system. Respond to regulatory
requirements impacting provider data including but not limited to
data points required by the healthcare industry, State and Federal
reports, audits and provider directory requirements. Manage
corporate key performance indicators. Implement and/or modify core
record keeping system to deliver and maintain accurate provider
Responsible for hiring, developing, and retaining the highest
quality Provider Data Specialists as needed.
Regularly analyze and report on the productivity and quality to
ensure effectiveness of the operations in comparison to established
performance metrics. Identify areas of improvement and recommend
Work cross-functionally to ensure operations and changes are well
Proactively seek feedback from other groups on the impact and
effectiveness of current and changes to operations.
Implement, manage, and refine business processes required to
deliver expected business results.
Keep abreast of relevant regulatory (pending and potential)
updates. Identify and plan for potential impact to operations.
Ensure relevant changes to operations and/or contractual
requirements can be supported.
Ensure operational compliance with all relevant regulatory
Ensure operations meet vendor/customer contractual
Proactively identify areas of concern or exceptions and promptly
Serve as a subject matter expert and provide peer support in a
mentoring or collaborative capacity in the office environment,
whether it be training or answering of questions, as deemed
appropriate by management.
Provides work direction, mentoring, and training to all staff as
Oversees daily activities of team.
Conducts performance reviews and evaluations for the Provider Data
Reviews and approves requests for time off. Manages calendar to
meet the needs of Provider Data Management team.
Monitor work of individual staff for productivity, attendance,
efficiency, effectiveness, and quality. Provide ongoing
constructive feedback and guidance to team.
Identifies and implements appropriate process improvements to
improve the quality of provider data and streamline workflows.
Attends internal and external meetings as required and represents
the Provider Data Management team as applicable.
Works to foster a positive and team-oriented spirit within the
Provider Data Management team and collaboratively within
Configuration and Support within Fallon Health
Develops and maintains tracking and monitoring systems to ensure
compliance and consistency or established standards and
Responsible for reporting of all applicable Provider Data
Management activities (inventory, competed, SLAs etc.
Responsible for operational metric reporting
Other duties as assigned.
Bachelor's degree or advanced education preferred
2+ years' experience at a health plan in Provider Data. Minimum 2
years of supervisory experience highly preferred.
Proficiency with call center workflow
Ability to identify efficient workflow for data administration
Experience with relational databases.
Knowledge of Microsoft programs and other reporting means to track,
update and analyze data.
Ability to coach, mentor, and maintain a positive work
Strong Communication and Presentation skills.
Strong Analytical Ability
Extensive knowledge of federal and state regulations, legislation
and laws, auditing reports and system functions; comparing
functions with established standards.
Ability to and experience in forecasting.
Ability to perform root causal analysis and impact assessments with
the goal of mitigation and/or process improvements
Fallon Health Vaccination Requirements:
To protect the health and safety of our workforce, members and
communities we serve, Fallon Health now requires all employees to
disclose COVID-19 vaccination status. As of 2/1/2022, all roles not
designated as "Remote" require full COVID-19 vaccination and Fallon
Health will obtain the necessary information from candidates prior
to employment to ensure compliance. Failure to meet the vaccination
requirement may result in rescission of an employment offer or
termination of employment.
Fallon Health provides equal employment opportunities to all
employees and applicants for employment and prohibits
discrimination and harassment of any type without regard to race,
color, religion, age, sex, national origin, disability status,
genetics, protected veteran status, sexual orientation, gender
identity or expression, or any other characteristic protected by
federal, state, or local laws.
Keywords: Fallon Health, Worcester , Provider Data Manager, Executive , Worcester, Massachusetts
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