Provider Roster Process Manager (Hybrid - Troy, MI) - Health Alliance Plan

GENERAL SUMMARY:

The Roster Manager role includes maintaining and managing the accurate information of healthcare providers within a network, ensuring their details are up-to-date, compliant with regulations, and readily accessible for patient access and billing purposes. Their role will utilize multiple dedicated software systems to streamline the process and facilitate efficient provider network data roster management. The primary responsibilities of the role will entail planning, organizing, directing, evaluating and coordination of roster data management as it relates to key Health Alliance Plan's (HAP) initiatives and provider service excellence within the Provider Network Management team. The ideal candidate should have extensive knowledge of the general regulatory guidelines for all lines of businesses within Michigan, to include Medicare, Commercial and Medicaid and industry best practices. They should be willing to work independently and collaboratively with cross-functional teams to ensure timely and accurate data delivery. The candidate should also be detail-oriented with strong written and verbal communication skills.

PRINCIPLE DUTIES AND RESPONSIBILITIES:

• High level oversight of rosters supplied by assigned provider partners, to include end-to-end management of workflow from receipt through effectuation into appropriate data systems.
• Facilitation between HAP and providers on roster submissions within multiple avenues of delivery systems.
• Perform data entry and cleaning activities, including discrepancy management and query resolution.
• Conduct data validation checks and implement quality control measures to ensure accuracy and completeness.
• Develop and execute standard operating procedures for roster management and multidepartment communications/facilitation.
• Collaborate with providers to resolve data-related issues and discrepancies within a roster while maintaining data accuracy.
• Contribute to the validation of data management software tools that are used when adding/terming/updating providers. Other key activities include project management, process improvement opportunities and being a SME for new system implementations.