Hi
Our client is looking for a Business Process SME (Provider Data Management) / Chief of Staff project in East Brunswick, NJ below is the detailed requirement.
Job positing Title: Business Process SME (Provider Data Management) / Chief of Staff
Location: East Brunswick, NJ
Job description:
• Bachelor’s degree in related field
• 15+ years of healthcare payer experience.
• 10+ years focused on Provider Data Management and Provider Operations.
• Deep knowledge of:
- Provider onboarding
- Credentialing and recredentialing
- Provider contracting
- Provider directory management
- Provider maintenance operations
- Provider network management
• Strong understanding of payment and reimbursement methodologies including capitation and risk-based models.
• Experience working with provider lifecycle management processes and systems. Provider lifecycle processes including intake, credentialing, contracting, provider data updates, recredentialing, pricing configuration, and rate loading are foundational capabilities in payer provider operations.
• Experience gathering business requirements and translating them into operational and system solutions.
• Strong stakeholder management and communication skills.
Preferred Qualifications
• Experience supporting UnitedHealthcare, Optum, or other large payer organizations.
• Experience with Facets Provider Module, NICE, NDB, Salesforce, or provider management platforms.
• Knowledge of provider pricing configuration, rate loading, and claims adjudication impacts. Provider pricing configuration and rate loading are key provider operations functions closely tied to reimbursement setup and downstream claims processing.
• Experience with provider data quality, compliance, and regulatory reporting.
• Familiarity with AI/automation solutions in provider operations and credentialing workflows.
Desired Skills
• Provider Data Management
• Provider Credentialing & Recredentialing
• Provider Onboarding
• Provider Contracting
• Provider Pricing & Capitation
• Network Management
• Healthcare Payer Operations
• Business Process Reengineering
• Facets provider modules
• Requirements Gathering
• Process Mapping
• Data Governance
• Regulatory Compliance
