Job Summary and Qualifications
The Data Management Manager is responsible for overseeing the daily operations of the Data management team. The Data Management team is responsible for ensuring that claims processing platform is optimally and accurately configured to meet the organization's strategic business operations. The Encounter team is responsible for designing, developing, and maintaining organizational programs that support contractual requirements of payer contracts, including but not limited to encounter programs. Additionally, this role will be responsible for leading and mentoring a team of technical professionals.
DUTIES INCLUDE BUT NOT LIMITED TO:
- Ensure claims processing platform is optimally and accurately configured and maintained to meet the organization's strategic business operational needs specific to vendor contracts, fee schedules, benefits/DOFR, and provider/vendor/place of service data. Responsible for developing and updating policies and procedures which support application system setup functions and work/audit processes within claims processing platform.
- Provider data management: Oversees the configuration of provider-specific data, including fee schedules, reimbursement methodologies, network assignments, and demographic information.
- Benefits configuration: Translates complex benefit plan documents (like Summary Plan Descriptions) into system rules, logic, and cost-sharing structures such as co-pays, deductibles, and out-of-pocket maximums
- Contract and pricing implementation: Accurately configures and tests new and updated provider contracts and pricing models to ensure correct claims payments according to negotiated terms.
- Coding and logic setup: Ensures the system correctly processes claims based on standard coding systems, including CPT, ICD-10, and HCPCS
- Represents the Data Management team to executive management and follows up with internal customers to ensure all business objective expectations are met. Works to established service levels per business requirements and acts as the primary point of escalation for the Data Management team.
- Manage yearly CMS rate change implementation and validation.
- Identifies opportunities to enhance operational efficiency, accuracy, and auto-adjudication rates within the claims system through workflow and process improvements.
- Establishes quality control metrics and tracking mechanisms for configurations. Manages testing and validation of all system changes before implementation.
- Works closely with other departments, including Claims Operations, IT, Provider Contracting, and Compliance, to align on system setup and resolve issues.
- Supports system migrations, client implementations, and other special projects that impact claims configuration.
- Acts as an escalation point for complex configuration and claims processing issues, performing root cause analysis and implementing corrective actions.
- Stays current with federal and state healthcare regulations (e.g., ACA, HIPAA) and ensures all system configurations comply with legal standards
- Coordinates responses to internal and external audits, implementing new processes to address any findings and ensure compliance.
- Monitors configuration performance and generates regular reports for management on quality metrics, system error rates, and team productivity.
- Create and lead a scalable program that includes encounter data management, submissions, reject remediation, and client/internal reporting as well as coordination and reconciliation with state regulatory bodies.
- Leads analyses independently and coordinates with the Finance Division to review financial performance based on encounter submissions.
- Perform other duties as assigned.
- This position requires the following minimum requirements
- Extremely strong verbal and written communication skills targeted at both high-level external stakeholders as well as internal peers and executives.
- Strong management and interpersonal skills to facilitate team towards achievement of stated functional goals as well as to help develop internal skill sets and performance.
- Advanced knowledge of healthcare, managed care, contract related activities including negotiations, legal, regulatory, operational, financial and relationship management.
EDUCATION:
- Bachelor's Degree or equivalent combination of education and 5+ years of work experience.
EXPERIENCE:
- 5+ years of experience in managed healthcare, analysis, and problem solving required.
- 5+ years of experience managing a team supporting managed healthcare systems/processes required.
- 7+ years professional managed healthcare administration experience in IPA with 5+ years management experience preferred
BenefitsWork from Home, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include:
- Comprehensive benefits for medical, prescription drug, dental, vision, behavioral health and telemedicine services
- Wellbeing support, including free counseling and referral services
- Time away from work programs for paid time off, paid family leave, long- and short-term disability coverage and leaves of absence
- Savings and retirement resources, including a 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service), Employee Stock Purchase Plan, flexible spending accounts, preferred banking partnerships, retirement readiness tools, rollover support and financial wellbeing counseling
- Education support through tuition assistance, student loan assistance, certification support, dependent scholarships and a partnership with Galen College of Nursing
- Additional benefits for fertility and family building, adoption assistance, life insurance, supplemental health protection plans, auto and home insurance, legal counseling, identity theft protection and consumer discounts
Learn more about Employee Benefits
Note: Eligibility for benefits may vary by location.Physician Services Group is skilled in physician employment, practice and urgent care operations. We are experts in hospitalist integration, and graduate medical education. We lead more than 1,300 physician practices and 170+ urgent care centers. We are HCA Healthcare's graduate medical education leader. We provide direction for over 260 exceptional resident and fellowship programs. We focus on carrying out value-added solutions. These solutions help physicians deliver patient-centered healthcare. We support HCA Healthcare's commitment to the care and improvement of human life.
HCA Healthcare has been recognized as one of the World's Most Ethical Companies® by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses.
"Bricks and mortar do not make a hospital. People do."- Dr. Thomas Frist, Sr.
HCA Healthcare Co-Founder
If you are looking for an opportunity that provides satisfaction and personal growth, we encourage you to apply for our Data Management Manager opening. We promptly review all applications. Highly qualified candidates will be contacted for interviews.
Unlock the possibilities and apply today!
