| Provider Data Management Lead || NYC - NY || Hybrid || No H1B || 6+ Months Contract || Local Only at New York City, New York, USA |
| Email: vikas@dmsvisions.com |
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https://shorturl.at/i6UrN https://jobs.nvoids.com/job_details.jsp?id=2210046&uid= From: vikas Chaudhary, DMS Vision Inc. vikas@dmsvisions.com Reply to: vikas@dmsvisions.com Hi, Hope you are doing well !! I have an urgent position. Kindly go through the Job description and let me know if this would be of interest to you. Job Title: Lead Provider Data Management Location: New York City , NY - Hybrid Duration: 6+ Months Contract Visa - No H1B ****While sharing resume mention consultant location and visa status*** Job Summary We are seeking an experienced Subject Matter Expert (SME) in Health Plan Provider Data Management to support our Business Process as a Service (BPaaS) Readiness Program within a Medicare Advantage environment. The ideal candidate will have deep expertise in provider data operations, systems integration, compliance, and process transformation to enable successful BPaaS implementation. Primary Responsibilities Provider Data Management & BPaaS Readiness Lead and drive provider data strategy, governance, and operational improvements in preparation for BPaaS adoption. Ensure seamless integration of provider data systems with BPaaS platforms, aligning with Medicare Advantage regulatory requirements. Identify, document, and address provider data pain points to enhance data integrity, accuracy, and usability. Define and implement best practices for provider data ingestion, validation, and maintenance to support operational efficiency. Medicare Advantage Compliance & Regulatory Oversight Ensure provider data management processes align with CMS guidelines, including provider directory accuracy, network adequacy, and regulatory reporting. Collaborate with compliance teams to monitor changes in Medicare Advantage regulations and assess their impact on provider data operations. Drive adherence to NCQA, CMS, and other regulatory standards related to provider data quality and transparency. BPaaS Transition & Process Optimization Partner with IT, operations, and third-party BPaaS vendors to ensure a smooth transition of provider data functions. Assess current provider data workflows, technology platforms, and operational models, recommending optimizations for BPaaS enablement. Develop data governance frameworks and quality control measures to ensure provider data readiness for BPaaS migration. Identify opportunities to automate and standardize provider data processes to improve scalability and efficiency. Stakeholder Collaboration & Change Management Act as a liaison between business, IT, vendors, and regulatory teams to align provider data management strategies with organizational goals. Lead training and knowledge transfer initiatives to educate internal teams on provider data best practices in a BPaaS model. Drive cross-functional collaboration to ensure provider data readiness supports network management, claims processing, and member experience. Education and Experience 10+ years of experience in health plan provider data management within a Medicare Advantage environment. Strong knowledge of BPaaS transformation initiatives and experience in operational readiness programs. Expertise in provider data governance, validation, and quality assurance in a payer setting. In-depth understanding of CMS regulations, Medicare Advantage provider network requirements, and compliance standards. Experience working with provider data platforms, EDI transactions (e.g., 834, 837, 835, 277), provider directories, and credentialing systems. Demonstrated ability to lead cross-functional teams, drive process improvements, and support large-scale technology transitions. Strong analytical, problem-solving, and project management skills. Excellent communication and stakeholder engagement abilities. Preferred Qualifications: Experience with cloud-based BPaaS platforms for healthcare payers (e.g., Cognizant TriZetto, HealthEdge, Salesforce Health Cloud). Knowledge of data interoperability frameworks (FHIR, API integrations) for provider data exchange. Six Sigma, PMP, or Lean Process Improvement certification is a plus. -- Thanks & Regards, Vikas Chaudhary Technical Recruiter Email: vikas@dmsvisions.com Linkedin : linkedin.com/in/vikas-chaudhary-922276346 Phone : 972-645-0989 Ext : 109 DMS Vision ,INC 4645 Avon Lane, Suite 210 Frisco, TX 75033 Keywords: information technology golang New York Texas Provider Data Management Lead || NYC - NY || Hybrid || No H1B || 6+ Months Contract || Local Only vikas@dmsvisions.com https://shorturl.at/i6UrN https://jobs.nvoids.com/job_details.jsp?id=2210046&uid= |
| vikas@dmsvisions.com View All |
| 01:13 AM 27-Feb-25 |