Description
We're building a world of health around every individual , shaping a more connected, convenient and compassionate health experience.
The Senior Manager, Provider Data Integrity leads provider data integrity, attribution governance, and related operational controls supporting Medicaid operations. This role serves as a key liaison between provider relations, provider data management, information technology, analytics, claims, and other operational departments to ensure that provider and attribution information are accurate, consistently maintained, and appropriately reflected in downstream systems and business processes.
Responsibilities
- Lead attribution, membership, and provider data governance processes to ensure accurate and reliable operational outputs.
- Oversee resolution of provider data and attribution issues that affect member assignment, reporting accuracy, and downstream operations.
- Partner with health plan leaders, network teams, provider data teams, claims, compliance, marketing, operations, and technology partners to deliver projects that support business performance, regulatory requirements, and customer experience.
- Support provider directory accuracy, audit readiness, and regulatory validation activities through monitoring, documentation, and issue remediation.
- Identify recurring defects, root causes, and control gaps, then drive process improvements that reduce rework and improve operational reliability.
- Maintain governance routines, process documentation, and cross-functional coordination for attribution and provider data operations.
Requirements
- 7-10 years of experience.
- 5+ years of experience in Medicaid, managed care operations, provider data, healthcare analytics.
- Experience with SQL, advanced Excel, Power BI, Tableau, or comparable analytical tools.
- Demonstrated ability to independently investigate, analyse, and reconcile complex health care data, identify root causes, and recommend corrective actions.
- Demonstrated experience investigating and resolving provider data issues, including discrepancies involving provider identifiers, affiliations, contractual relationships, etc.
- Experience coordinating cross-functional issue resolution and operational improvements.
- Strong communication skills, including the ability to translate complex operational issues into clear business risk, action plans, and ownership.
Preferred Qualifications
- Experience managing provider attribution methodologies, governance, reporting, and operational execution.
- Experience leveraging QNXT and Medicaid Data Warehouse (MDW) data to support operational decision-making, reporting, and issue resolution.
- Experience investigating member attribution or provider assignment discrepancies.
- Experience managing, validating, or reconciling provider rosters, including identifying and resolving inconsistencies across systems.
- Experience managing provider data, directory accuracy, or related operational issues across multiple teams.
Education
- Bachelor's degree or equivalent professional experience.
Pay Range
$67,900.00 - $199,144.00
Benefits
This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.