Manager, Provider Data Management

Role Overview

• Serve as the direct people leader for multiple teams responsible for Provider Enrollment, Auditing, and Provider Data Management & Updates.
• Manage, coach, and develop staff through performance management, training, and career development.
• Establish staffing models, productivity expectations, and cross ‑ functional alignment to support business and regulatory needs.
• Update and maintain training materials, policies, and standard operating procedures to ensure consistent execution across teams.
• Provide operational ownership and oversight of the health plan’s entire Provider Enrollment lifecycle , including initial enrollment, revalidation, updates, and terminations.
• Oversee provider enrollment auditing activities to ensure compliance with state, federal, NCQA, CMS, and contractual requirements.
• Provide oversight and governance of the Centene Corporate credentialing process , ensuring alignment, issue escalation, and audit readiness at the health plan level.
• Partner with internal and external stakeholders to resolve enrollment, credentialing, and data discrepancies.
• Ensure the timely and accurate processing of provider data updates (adds, changes, and terminations) across all systems.
• Develop and maintain data integrity through audits, controls, reporting, and root ‑ cause analysis.
• Establish and monitor KPIs and operational goals for Provider Enrollment and Provider Data Management functions.
• Manage encounter response files and error correction processes related to provider data.
• Lead provider data and enrollment audit preparation and execution, including internal, state, federal, and accreditation audits.
• Track audit findings, corrective action plans, and ongoing monitoring activities.
• Schedule and oversee monthly provider verifications related to enrollment specifications and demographic changes, particularly for designated specialty types.
• Responsible for systems implementation, enhancements, and process improvements related to provider enrollment and data management.
• Coordinate materials and provider data support for Requests for Applications (RFAs) , new business, and expansions.
• Collaborate with internal business partners to support enterprise initiatives and regulatory changes

Requirements

• Bachelor’s degree in related field or equivalent experience
• 4+ years of contracting, provider data management, or data analytics experience
• Supervisor/lead experience preferred

Benefits

• competitive pay
• health insurance
• 401K and stock purchase plans
• tuition reimbursement
• paid time off plus holidays
• a flexible approach to work with remote, hybrid, field or office work schedules