Kforce has a client in search of a Data Management Specialist in Miami, Florida (FL).
The incumbent serves a key role, responsible for the strategic and tactical direction of all development, staffing, planning, managing, and measuring the overall activities for the entire division related to every aspect of Adhoc Provider Authorizations and Referrals, to all types of providers. The position is responsible for developing and implementing national and regional plans that meet new and existing customer requirements, assures member access to qualified providers for authorized services, and collaborates with key leaders (CMC and Field Network) to maintain limits for budget plan/cost of care projections. This position serves as the strategic business partner to other leadership from all areas of the organization: CMC, Network Sales, Sales, Account Management, Training, and client-wide to convey process related trends and statistical data in support of each of these departments' business strategies.
Essential Job Functions:
* Establishes overall direction, plan, policy and procedural documentation for department to ensure compliance with corporate policies, customer requirements, reporting requirements, best practices and process efficiencies, related to requests for seeking, qualifying, and documenting and contracting out-of-network providers
* Ensures timely and appropriate response to all requests
* Responsible for development, modification, maintenance and review of Adhoc contracts, agreements and addenda, in conjunction with Corporate Legal Counsel, in addition to Provider Authorization and Referral policy
* Member of project team in planning and development for processes and ACES system enhancements, and engages relevant leadership from other departments, including development and delivery of training, as necessary, (i.e. Network Field, Network Services, Account Management, IT, and Care Management centers)
* High School/GED required
* 1-2 years of health care administration experience (finance/contract administration, physician/provider relations, technical writing for policy & procedural) with strong preference for managed care experience
* Credentialing experience is a major plus; The candidate will be reaching out to providers to request any credentialing documents
* Proven ability to strategically lead an organization toward the attainment of its goals and objectives, mission and values
* Microsoft Office: Word, Excel, and Access
* Excellent organizational skills required
* Excellent communication and negotiation skills
* Demonstrated team building skills to promote an environment of diversity, collaboration, and recognition
* Must have effective problem-solving skills
* Must have excellent writing skills
* Ability to handle multiple tasks at one time
* Must have the ability to be and work as a team member & provide support to team members as assigned
Of progressively more responsible health care administration experience (finance/contract administration, physician/provider relations, technical writing for policy & procedural) with strong preference for managed care experience.
Kforce is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, pregnancy, sexual orientation, gender identity, national origin, age, protected veteran status, or disability status.