Manager of Provider Data

Role Description

Manager of Provider Data

Manager I – BPM

Who We Are

UST HealthProof is a trusted partner for health plans, offering an integrated ecosystem for health plan operations. Our BPaaS solutions manage complex admin tasks, allowing our customers to prioritize members’ well-being. With our commitment to simplicity, honesty, and leadership, we navigate challenges with our customers to achieve affordable health care for all.

We have a strong global presence and a dedicated workforce of over 4000 people spread across the world.

Our brand is built on the strong foundation of simplicity, integrity, people-centricity, and leadership. We stay inspired in our goal to unburden healthcare and ensure it reaches all, equitably and effectively.

You Are

UST HealthProof is looking for a Manager of Provider Data, reporting to the Director of Business Operations. The Manager of Provider Data is responsible for managing the integrity and accuracy of provider data. This role will lead a team of professionals dedicated to maintaining high standards of data management, fostering collaboration across departments, and supporting the health plan's commitment to quality.

The Opportunity

• Develop and implement policies, procedures, and best practices for managing provider data to ensure consistency and efficiency.
• Perform analytics to identify and research trends for data completeness and accuracy.
• Oversee the end-to-end provider data entry and maintenance and to ensure the accuracy of provider data for timely set up for claims payment, member benefit assignment, and provider directory display (including demographic information, practice locations, and network participation).
• Participate in cross-functional collaboration with Claims Operations, Credentialing, Provider Relations, Network Management, Customer Service, Technology Operations, and Compliance to ensure seamless and timely integration of provider data.
• Monitor and report on key performance indicators (KPIs) related to provider data management, highlight trends, identify areas for improvement, and implement corrective actions as needed.
• Lead, mentor, and develop a team of onshore and offshore provider data management professionals, fostering a culture of continuous improvement and professional growth.
• Coordinate audits and reviews of provider data management processes, respond to findings, and implement necessary improvements.
• Serve as the primary point of contact for internal and external stakeholders regarding provider data management inquiries and issues.
• Participate in strategic planning and initiatives to support client goals and objectives.
  
  

This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required.

What You Need

• Associate or bachelor's degree in healthcare administration, business administration, or a related field.
• Minimum of 7-10 years of experience in credentialing or provider data management in the healthcare industry.
• Proven leadership and management experience, with a track record of successfully leading teams and driving process improvements.
• In-depth knowledge of credentialing and provider data management standards, regulations, and accreditation requirements (e.g., NCQA, URAC).
• Strong analytical, problem-solving, and decision-making skills, with the ability to interpret and act on complex data.
• Excellent communication and interpersonal skills, with the ability to build relationships and collaborate effectively with internal and external stakeholders.
• Proficiency in using credentialing and provider data management software and systems.
• Detail-oriented, with a commitment to accuracy and data integrity.
  
  

Compensation can differ depending on factors including but not limited to the specific office location, role, skill set, education, and level of experience. UST HealthProof provides a reasonable range of compensation for roles that may be hired in various U.S. markets as set forth below.

Role Location: Remote

Compensation Range: $75,000-$85,000

Benefits

Full-time, regular employees accrue up to 16 days of paid vacation per year, receive 6 days of paid sick leave each year (pro-rated for new hires throughout the year), 10 paid holidays, and are eligible for paid bereavement leave. They are eligible to participate in the Company’s 401(k) Retirement Plan with employer matching. They and their dependents residing in the US are eligible for medical, dental, and vision insurance, as well as the following Company-paid benefits: basic life insurance, accidental death and disability insurance, and short- and long-term disability benefits. Regular employees may purchase additional voluntary short-term disability benefits, and participate in a Health Savings Account (HSA) as well as a Flexible Spending Account (FSA) for healthcare, dependent child care, and/or commuting expenses. Certain regular employees may have the potential for quarterly incentive-based bonuses and or commissions depending on role. Benefits offerings vary in Puerto Rico.

Part-time employees receive 6 days of paid sick leave each year (pro-rated for new hires throughout the year) and are eligible to participate in the Company’s 401(k) Retirement Plan with employer matching.

Full-time temporary employees receive 6 days of paid sick leave each year (pro-rated for new hires throughout the year) and are eligible to participate in the Company’s 401(k) program with employer matching. They and their dependents residing in the US are eligible for medical, dental, and vision insurance.

Part-time temporary employees receive 6 days of paid sick leave each year (pro-rated for new hires throughout the year).

All US employees who work in a state or locality with more generous paid sick leave benefits than specified here will receive the benefit of those sick leave laws.

What We Believe

At UST HealthProof, we envision a bold future for American healthcare. Our values are the bedrock beliefs our organization holds dear. They not only define what our brand stands for but also serve as a compass guiding every action and decision.

Guiding Principles

These principles illuminate the path of ‘how’ we operate. They detail actions and behaviors we much embody to honor our values and achieve our goals.

• Simplicity
  
  

Simplifying complexity underlines everything we do—this approach is what makes us unique. We come with an open mind and straightforward approach, cutting our way to the core with measurable and actionable insights.

• Integrity
  
  

Integrity is our currency to build relationships. We believe in being open and honest. It is only natural when we have nothing to hide. It demonstrates that we are here to do the right thing, no matter who is watching.

• People-Centricity
  
  

Everything that we do reflects our deep bonds with peers and customers. These aren't mere transactions, but transformational ties. They shape our culture and decisions, affirming that our true value lies in the lives we touch and impact.

• Leadership
  
  

Taking ownership is about taking initiative, being in-charge and driving things to completion. It’s a brave choice to ‘own’ all aspects of our work, ensuring we take full responsibility for everything we handle.

Mission

A future possible only when health plans are free from administrative burdens so they can truly focus on what matters more – their members’ well-being.

Equal Employment Opportunity Statement

UST HealthProof is an Equal Opportunity Employer.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other applicable characteristics protected by law. We will consider qualified applicants with arrest or conviction records in accordance with state and local laws and “fair chance” ordinances.

UST HealthProof reserves the right to periodically redefine your roles and responsibilities based on the requirements of the organization and/or your performance.

#Healthproof

#CB

Skills

Network Management,Relationship Management,Ms Excel