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Position : Provider Data management lead (Hybrid)
Location : New York || Locals only
Duration : 6 Months
Job Description
We are seeking an experienced Subject Matter Expert (SME) in Health Plan Provider Data Management to support our Business Process as a Service (BPaaS) Readiness Program within a Medicare Advantage environment. The ideal candidate will have deep expertise in provider data operations, systems integration, compliance, and process transformation to enable successful BPaaS implementation.
Primary Responsibilities
Provider Data Management & BPaaS Readiness
- Lead and drive provider data strategy, governance, and operational improvements in preparation for BPaaS adoption.
- Ensure seamless integration of provider data systems with BPaaS platforms, aligning with Medicare Advantage regulatory requirements.
- Identify, document, and address provider data pain points to enhance data integrity, accuracy, and usability.
- Define and implement best practices for provider data ingestion, validation, and maintenance to support operational efficiency.
Medicare Advantage Compliance & Regulatory Oversight
Ensure provider data management processes align with CMS guidelines, including provider directory accuracy, network adequacy, and regulatory reporting.Collaborate with compliance teams to monitor changes in Medicare Advantage regulations and assess their impact on provider data operations.Drive adherence to NCQA, CMS, and other regulatory standards related to provider data quality and transparency.BPaaS Transition & Process Optimization
Partner with IT, operations, and third-party BPaaS vendors to ensure a smooth transition of provider data functions.Assess current provider data workflows, technology platforms, and operational models, recommending optimizations for BPaaS enablement.Develop data governance frameworks and quality control measures to ensure provider data readiness for BPaaS migration.Identify opportunities to automate and standardize provider data processes to improve scalability and efficiency.Stakeholder Collaboration & Change Management
Act as a liaison between business, IT, vendors, and regulatory teams to align provider data management strategies with organizational goals.Lead training and knowledge transfer initiatives to educate internal teams on provider data best practices in a BPaaS model.Drive cross-functional collaboration to ensure provider data readiness supports network management, claims processing, and member experience.Education and Experience
10 years of experience in health plan provider data management within a Medicare Advantage environment.Strong knowledge of BPaaS transformation initiatives and experience in operational readiness programs.Expertise in provider data governance, validation, and quality assurance in a payer setting.In-depth understanding of CMS regulations, Medicare Advantage provider network requirements, and compliance standards.Experience working with provider data platforms, EDI transactions (e.g., 834, 837, 835, 277), provider directories, and credentialing systems.Demonstrated ability to lead cross-functional teams, drive process improvements, and support large-scale technology transitions.Strong analytical, problem-solving, and project management skills.Excellent communication and stakeholder engagement abilities.Preferred Qualifications :
Experience with cloud-based BPaaS platforms for healthcare payers (e.g., Cognizant TriZetto, HealthEdge, Salesforce Health Cloud).Knowledge of data interoperability frameworks (FHIR, API integrations) for provider data exchange.Six Sigma, PMP, or Lean Process Improvement certification is a plus.Please share your updated resume and suggest the best number & time to connect with you
Thanks & Regards,
Yashwant Singh
US IT Recruiter
dmsvisions.com /
E : Yashwant@Dmsvisions.com
T : 972-645-5050 / 106
A : 4645 Avon Lane, Suite 210, Frisco, TX 75033, Zip Code, Country
