Sensiple Inc is a New Jersey corporation with over two decades of expertise in technology-driven solutions specializing in Customer Experience, Contact Center Solutions, Digital Transformation, Cloud Computing & Independent Testing.
With an expert team that has enriched experience in executing & developing sustainable IT strategies in Healthcare, Technology, Retail, Logistics, Education, Telecommunications, Government and Media, we help our diverse customers to envision the future.
By developing highly scalable and consistent solutions, our primary goal is to deliver excellence at all levels and delight our customers and drive them to a better future.
One of our client is looking for a Domain Expert for PLM Stream @ NYC NY Please find below the details of the position.
Job Role: Domain expert for PLM stream
Location: NYC, NY (Hybrid Model)
Contract
Job Description: Business, Technology & Performance Metrics Improvement SME Provider Lifecycle Management (AI-First Consulting)
- Role Overview
We are seeking a high-caliber Business, Technology & Performance Metrics Improvement Subject Matter Expert (SME) Provider Lifecycle Management (PLM) to join our elite Healthcare Technology Consulting practice. As an AI-first and engineering-oriented technology solutions organization, we partner with leading healthcare enterprises, Health Plans, and Health Systems to radically modernize their core operations through cutting-edge artificial intelligence, robust engineering, and data-driven transformation.
This role demands deep domain mastery across the full Provider Lifecycle Management ecosystem including Provider Network Management, Credentialing, Contracting, Primary Source Verification (PSV), Enrollment, Onboarding, Directory Management, and Provider Data Architecture. You will lead client-facing engagements, driving AI-led end-to-end operational and technical assessments, designing modern target state architectures, and implementing technology-led metric improvements that optimize organizational performance, lower operating costs, and reduce provider onboarding velocity from months to days.
- Key Responsibilities-Led End-to-End Diagnostic & Operational Assessments
- Lead comprehensive diagnostic assessments of clients' end-to-end Provider Lifecycle Management (PLM) ecosystem, evaluating current-state business processes, technical architecture, provider data governance, and operational bottlenecks.
- Deploy proprietary and custom AI tools, machine learning diagnostic frameworks, and automated process mining to analyze workflow latency, data quality leaks, manual touchpoints, and handoff inefficiencies.
- Benchmark client operations against industry-leading performance metrics, regulatory mandates (NCQA, URAC, CMS provider directory mandates, No Surprises Act), and best-in-class technology standards.
- Deliver executive-ready assessment blueprints, ROI models, and transformation roadmaps that articulate the quantitative business case for AI-driven PLM modernization.
Provider Lifecycle Domain & Business Optimization
- Serve as the principal subject matter expert across all PLM sub-domains: Provider Data Management (PDM), Credentialing & Re-credentialing, CAQH integration, Contract Management, Network Tiering, Provider Directory Accuracy, and Provider Portal experience.
- Architect frictionless provider onboarding and enrollment journeys that eliminate redundant manual data entry, streamline Primary Source Verification (PSV), and automate roster processing.
- Define and enforce data quality standards for provider master data management (MDM), single source of truth (SSOT) data models, National Provider Identifier (NPI) lookup, and taxonomy structures.
- Guide health plan and health system clients on compliance with evolving federal and state provider regulations, ensuring continuous audit readiness.
Technology-Led Improvement & Disruptive AI Solution Design
- Partner with our core software engineering, data science, and solution architecture teams to design and implement AI-first PLM software tools, automation agents, and integration engines.
- Architect disruptive AI solutions, including Generative AI and LLMs for automated contract abstraction and parsing, NLP engines for provider roster and unstructured document ingestion, and computer vision/OCR pipelines for credentialing verification.
- Design real-time API integration strategies connecting PLM platforms with Core Administrative Processing Systems (CAPS/Facets/QNXT), EHR systems, CAQH, NPDB, State Licensing Boards, and CRM platforms (Salesforce Health Cloud).
- Establish robust AI governance frameworks, human-in-the-loop (HITL) exception handling, and data validation guardrails to ensure 100% precision in provider network data.
Organizational Performance Metrics & Operational Engineering
- Establish, track, and continuously optimize core organizational performance metrics across client PLM operations. Key target metrics include:
- Time-to-Network / Days-to-Credential: Accelerating onboarding speed from industry averages (90 120 days) down to target benchmark levels (< 14 days).
- Touchless Automation Rate: Maximizing straight-through processing (STP) for provider roster ingestion and Primary Source Verifications.
- Provider Directory Accuracy: Elevating data accuracy to > 98% to satisfy No Surprises Act mandates and eliminate ghost directories.
- Cost per Provider Onboarded: Significantly reducing administrative unit costs via intelligent automation.
- Provider Satisfaction Score (CSAT/NPS): Streamlining provider interaction touchpoints and portal friction.
Establish real-time operational dashboarding, telemetry, and reporting architectures to give client executives visibility into pipeline performance, SLA breaches, and productivity metrics.
If you find yourself suitable for this position, kindly send your updated resume and expected hourly rate to elangovan dot t at sensiple dot com
Regards
Elangovan T | Sensiple Inc.,
elangovan dot t at sensiple dot com
555 US Highway 1 S, Ste 330 Iselin, NJ 08830
Sensiple, Inc. is an Equal Opportunity Employer, and all qualified applicants will receive consideration for employment without regard to gender, race, colour, religion, sex, national origin, veteran or disability status.
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