Job Summary:

The Team Lead, Provider Data Integrity performs supervision and support of the Provider Data Integrity (PDI) team.

Essential Functions:

• Perform supervision and support of the Provider Data Integrity (PDI) team
• Manage key PDI functions to meet regulatory and operational responsibilities for the Ohio provider panel, and ensure accurate provider information in applicable CareSource systems
• Responsible for accurate and timely processing of provider additions, terminations, and changes to meet regulatory requirements and maintain provider panel information for CareSource products
• Supervise, mentor, and coach staff, and ensure appropriate staff training
• 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
• Assure that data entry activities are accurate, timely, and compliant with state and regulatory standards
• Respond to calls and emails from internal/external customers
• Coordinate efforts with Provider Relations (PR) and Credentialing to complete all applications missing components
• Continuously monitor all PDI work queues to ensure Turn Around Times (TAT) are being met
• Weekly monitoring of aging of files and working with PDI staff to close in order to meet Service Level Agreements and report to Manager any trends or patterns
• Actively participate in the Operations Management Team and meetings
• Assist with performance evaluations, hiring, and disciplinary action decisions
• Maintain time sheets for non-exempt employees
• 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 related instructions, as requested

Education and Experience:

• Associates Degree in business or related field or equivalent years of relevant work experience is required
• Minimum of three (3) years provider data or supervisory experience is required
• Previous experience in a managed care organization is preferred

Competencies, Knowledge and Skills:

• Intermediate computer skills
• Proficiency in Microsoft Word, Outlook and Excel
• 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:

CareSource takes into consideration a combination of a candidates education, training, and experience as well as the positions 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 employees total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type (hourly/salary):

Organization Level Competencies

• Fostering a Collaborative Workplace Culture

• Cultivate Partnerships

• Develop Self and Others

• Drive Execution

• Influence Others

• Pursue Personal Excellence

• Understand the Business