DIR PROVIDER DIRECTORIES in Boston, MA at Beacon Health Options

Date Posted: 7/8/2018

Job Snapshot

Job Description

ABOUT THE POSITION:

We are currently seeking a dynamic  Director, Provider Directories  to join the Beacon Team.  The  Director, Provider Directories is responsible to oversee all activities and initiatives to ensure the accuracy of Beacon’s provider directories. The DPD will partner with Network Operations, Provider Relations, Provider Contracting, EDI, Information Technology and the Project Management Office to execute strategic initiatives and the associated change management required to maintain accurate and compliant provider directories. Work in a matrix environment and use informal influence to bring colleagues across the enterprise together to be collectively successful.

Duties and Responsibilities

  1. Project owner of initiative to establish new model for maintaining accurate provider directories that meet regulatory and client requirements.
  2. Research independently and/or coordinate with the Legal department to stay current on provider directory legislation and requirements set by CMS, States, and other regulatory or accrediting entities.
  3. Establish and document processes for confirmation of provider demographic and availability information, consequences for providers who do not update their information and maintenance of provider status as a result of whether a provider updates their information or not.
  4. Partner with IT and EDI teams to set requirements for, facilitate and prioritize IT and EDI work required for changes and maintenance of provider directories.
  5. Oversee maintenance of provider data feeds, including trouble-shooting and partnering with EDI team to assure timely and accurate feeds are sent and received.
  6. In collaboration with Procurement department, oversee relationships with vendors, including contract management, assuring all contractual and service level requirements are being met by vendors.
  7. Oversee, facilitate and compile results and reports related to secret shopper calls, audits and surveys. Implement interventions as appropriate in response to results.
  8. Partner with Marketing Communications department to write and facilitate distribution of provider communications related to provider directory initiatives.
  9. Coordinate with Region Operations teams to develop member communications.
  10. Lead responses to investigations by clients or regulatory bodies.
  11. Partner with Network Management teams to assure new processes are operationalized, P&Ps are followed, and outcomes are achieved. Develop tracking processes to monitor compliance with new processes.
  12. Other duties as assigned.

Years and Type of Relevant Work Experience:

  • Education:     Bachelor’s degree preferred
  • Licensures:      N/a

Years and Type of Relevant Work Experience:

  • At least five years’ experience in a health insurance organization, managed care preferred. 
  • Project management experience.
  • Vendor management or related experience preferred.
  • Professional demeanor, strong written and oral communication skills, and strong computer skills.
  • Detail-oriented, analytical, highly organized and possessing problem-solving skills.
  • Ability to manage varying job pressures, and meet deadlines and handle multiple tasks simultaneously with minimal supervision.
  • Computer literacy and experience with Microsoft office programs (Outlook, Word, PowerPoint and Excel). Experience working with fax machines, copiers and other office equipment.

TO APPLY

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Beacon Health Options is proud to be an Equal Opportunity Employer as well as a Drug Free Work Environment. EOE/M/F/Veterans/Disabled