Director, Provider Data Operations

About the role

The Director, Provider Data Operations role is within SCAN Group, a not-for-profit organization dedicated to senior healthcare. This role is crucial for ensuring that provider information is accurate, complete, and trusted across the enterprise.

Responsibilities

• Leads end-to-end provider data operations, including provider hierarchy, records, verification, roster management, reconciliation, delegated oversight, audit readiness, issue resolution, and continuous improvement.
• Owes provider data accuracy and directory integrity by establishing quality standards, validation controls, audit processes, and root-cause resolution to prevent recurring data defects.
• Owns data accuracy on internal and external provider directories.
• Drives strategy and governance for provider data as a trusted enterprise source of truth, including policies, procedures, business rules, data stewardship, and alignment with downstream systems and workflows.
• Ensures regulatory and business readiness by maintaining controls that support CMS and state requirements, network adequacy, provider directory accuracy, product participation, provider terminations, and delegated oversight.
• Understands and implements new and future compliance requirements.
• Supports critical business strategies by providing systematic solutions and/or recommendations on business processes.
• Proficient in navigating legislative changes, federal and state regulations, to direct teams to make necessary changes.
• Directs small and medium projects and initiatives.
• Define and deliver initiatives according to agreed-upon business requirements and timelines.
• Partners across Operations, Technology, Network Management, Compliance, Product, Digital, vendors, and delegated provider groups to integrate, govern, and improve provider data across enterprise processes.
• Leads implementation, optimization, and oversight of provider data applications, vendor solutions, automation, and AI-enabled capabilities that improve accuracy, efficiency, workflow performance, and decision-making.
• Maintains performance against KPIs, SLAs, quality measures, and risk indicators; translate trends into actionable insights, recommendations, and operational action plans.
• Proactively identifies opportunities for process improvements.
• Establishes departmental policies, practices, and procedures that have a significant impact on the organization.
• Oversee the creation of document workflows and policies and procedures (P&Ps) as necessary.

Qualifications

• Bachelor's Degree or 5+ years equivalent work experience; 2+ years of leadership experience
• 2+ years in leading Provider Data Management teams at managed care provider organization (IPA, Medical Group or institutional provider) or insurance company
• 5+ years of overall Healthcare experience

What's in it for you?

• Base Pay Range: $147,900-$205,000
• SalaryWork Mode: Remote
• An annual employee bonus program
• Robust Wellness Program
• Generous paid-time-off (PTO)
• 11 paid holidays per year, 1 floating holiday, birthday off, and 2 volunteer days
• Excellent 401(k) Retirement Saving Plan with employer match
• Roads to Leadership
• Tuition reimbursement
• An opportunity to become part of a team that makes a difference to our members and our community every day!