Data Management Lead

Requires high school diploma or equivalent.
Requires three years’ experience as a Provider Data Management Rep or three years claims processing proficiency using Facets.
Requires seven plus years of data entry experience.
Requires effective written and verbal communications skills to answer questions from staff and respond to inquiries.
Requires analytic ability to prepare departmental reports. Requires the ability to compare data and resolve discrepancies.
Must have thorough knowledge of Provider Data Management policy and procedures.
Requires proficiency with Word and Excel.

Monitors the workflow of Provider Data Management staff.
Prepares responses to correspondence and handles assigned projects.
Answers questions from Provider Data Management staff regarding format and procedures for various provider records. Handles reviews of specific provider situations as requested.
Reviews and audits debarred, and suspended provider reports received from OPM/OIG.
Handles priority pre-certification cases.
Functions as a lead or back-up in the absence of the Supervisor Provider Data Management.
Updates and completes daily, monthly, and annual reports.
Makes recommendations to improve quality, workflow processes, policies and procedures.
Contributes independently and collaboratively across departments and cross-functional projects.
Analyzes audit reports and rebuttals to identify trends and recommend determination of outcome.
Provides training on desk level procedures and policies. Conducts desk level procedure retraining when needed.
Audits claims coding, customer service calls or electronic files for accuracy, benefit payment, contract interpretation, and compliance with policies and procedures as needed.