• Job Description

  Req#: R9641

  Job Summary:

  The Manager, HP Data Reconciliation develops and manages all processes related to inbound and outbound provider data files

  Essential Functions:

  • Perform supervision and support of the Health Partner Lifecycle (HPLC) Data Reconciliation team members
  • Develop and manage all processes related to inbound and outbound provider data files
  • Responsible for accurate and timely updates to data exceptions
  • Provide direction and oversight of business processes to ensure accurate setup and maintenance of defined provider information in applicable systems, and ensure compliance with provider contract documents
  • Maintain subject matter expertise of all supported provider data files
  • Assure that data entry activities are accurate, timely, and compliant with state and regulatory standards
  • Develop, document and perform testing and validation as needed for process and system changes
  • Serve as primary point of contact for vendors and business partners that are sending and receiving CareSource provider data
  • Coordinate efforts with markets and other CareSource departments to ensure all data needs are met
  • Actively participate in the Operations Management Team and meetings
  • Conduct performance evaluations, hiring, and disciplinary action decisions
  • Conduct root cause analysis on escalated issues
  • Coordinate data entry activities related to assignments, problem solving, and project management
  • Supervise staff for quality review, performance feedback, disciplinary issues, and merit/bonus appraisal review
  • Create, review, revise, and enforce company and departmental policies and procedures
  • Provide mentoring, training, and ongoing education in regards to optimal performance and Standards of Excellence
  • Perform any other job duties as requested

  Education and Experience:

  • Bachelor’s Degree in business, healthcare or related field or equivalent years of relevant work experience is required
  • A minimum of three (3) years of experience in data analysis and/or root cause analysis required
  • A minimum of three (3) years of experience working with operations or IT is required
  • A minimum of three (3) years of experience in a leadership role is required
  • Experience working with provider data preferred
  • Experience working with Excel, SQL, and Microsoft Access preferred

  Competencies, Knowledge and Skills:

  • Advanced computer skills, specifically working with data
  • Proven understanding of business process
  • Proven critical thinking and analysis skills
  • Experience writing and/or interpreting system requirements preferred
  • Communication skills
  • Ability to work independently and within a team environment
  • Training/teaching skills
  • Attention to detail
  • Ability to effectively support diverse personalities and work styles
  • Familiarity of the healthcare field
  • Knowledge of Medicaid
  • Critical listening and thinking skills
  • Strategic management skills
  • Use of proper grammar
  • Technical writing skills
  • Time management skills
  • Proper phone etiquette
  • Customer service oriented
  • Decision making/problem solving skills
  • Knowledge of medical terminology
  • Ability to identify and recommend process improvements

  Licensure and Certification:

  • None

  Working Conditions:

  • General office environment; may be required to sit or stand for extended periods of time

  Compensation Range:

  $81,400.00 - $130,200.00

  CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

  Compensation Type (hourly/salary):

  Salary

  Organization Level Competencies

  • Create an Inclusive Environment

  • Cultivate Partnerships

  • Develop Self and Others

  • Drive Execution

  • Influence Others

  • Pursue Personal Excellence

  • Understand the Business

  
  

  This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an inclusive environment that welcomes and supports individuals of all backgrounds.

  #LI-SD1

• About the company

  CareSource is a nonprofit that began as a managed health care plan serving Medicaid members in Ohio.

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