Job Title: Business Process SME – Provider Data Management / Chief of Staff

Location: East Brunswick, NJ
Work Arrangement: Hybrid – 3 days onsite per week
Experience: 15+ years

Job Summary

We are seeking a highly experienced Business Process SME – Provider Data Management / Chief of Staff with extensive healthcare payer experience, deep knowledge of provider lifecycle management, and strong strategic program leadership capabilities.

The ideal candidate will bring expertise in provider data management, provider onboarding, credentialing, contracting, provider network operations, and reimbursement methodologies. The candidate must also demonstrate strong executive stakeholder management, business process transformation, governance, and experience with AI-driven automation initiatives.

Experience supporting large healthcare payer organizations such as UnitedHealthcare, Optum, or similar organizations is highly desirable.

Key Responsibilities

Provider Data Management

• Lead end-to-end provider data lifecycle management, including provider setup, maintenance, updates, terminations, and directory management.
• Ensure the accuracy and integrity of provider demographics, specialties, affiliations, and network participation data.
• Establish provider data governance, quality controls, audit processes, and regulatory compliance standards.
• Drive continuous improvement in provider data management operations.

Provider Onboarding and Contracting

• Manage provider onboarding activities from contracting through production readiness.
• Coordinate with provider network, contracting, credentialing, and operations teams.
• Identify onboarding bottlenecks and implement process improvements.
• Support provider roster management, provider data conversion, and large-scale transformation initiatives.

Credentialing and Recredentialing

• Provide subject matter expertise in credentialing, recredentialing, and provider enrollment workflows.
• Ensure compliance with applicable NCQA, CMS, state, and payer-specific requirements.
• Support Primary Source Verification (PSV), sanctions monitoring, and credentialing committee processes.
• Identify opportunities for workflow automation and AI-enabled improvements.

Pricing and Reimbursement

• Demonstrate strong understanding of Fee-for-Service (FFS), capitation, value-based care, risk-sharing arrangements, shared savings, and bundled payment models.
• Support provider contract interpretation and pricing configuration requirements.
• Partner with business and configuration teams on provider reimbursement rules, fee schedules, and rate loading.
• Analyze provider contract impacts on claims adjudication and payment accuracy.

Business Process Excellence and Transformation

• Document current-state and future-state business processes.
• Lead workshops with provider operations, contracting, credentialing, and network management teams.
• Develop business requirements, process flows, standard operating procedures, and training materials.
• Drive business process reengineering, workflow optimization, and operational transformation.
• Identify opportunities to leverage AI and automation in provider operations.

Chief of Staff and Executive Stakeholder Management

• Partner with senior leadership and VP-level stakeholders to drive strategic initiatives and business priorities.
• Establish program governance, operating rhythms, executive reporting, and action tracking.
• Coordinate cross-functional teams to ensure timely execution of strategic programs.
• Prepare leadership presentations, status reports, risk assessments, and decision documents.
• Identify and resolve program dependencies, operational challenges, and execution risks.

Required Qualifications

• 15+ years of experience in healthcare payer operations, healthcare consulting, or related healthcare transformation programs.
• 10+ years of hands-on experience in provider data management and provider operations.
• Strong expertise in provider lifecycle management, including onboarding, credentialing, contracting, provider maintenance, recredentialing, and network management.
• Experience with provider pricing configuration, rate loading, reimbursement methodologies, and claims adjudication impacts.
• Strong knowledge of provider data governance, data quality, regulatory compliance, and operational controls.
• Proven experience gathering business requirements and translating them into business processes and system solutions.
• Strong executive communication, stakeholder management, and program leadership capabilities.
• Demonstrated experience with AI, intelligent automation, or AI-enabled business process transformation.
• Ability to work onsite in East Brunswick, NJ, three days per week.

Preferred Qualifications

• Experience with UnitedHealthcare, Optum, or other large healthcare payer organizations.
• Consulting experience with Big Four firms, Accenture, or similar consulting organizations.
• Experience in senior consulting, program management, transformation