Director, Provider Network Operations

Looking for a way to make an impact and help people? Join PacificSource and help our members access quality, affordable care! PacificSource is an equal opportunity employer.

All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, sex, sexual orientation, gender identity, national origin, genetic information or age.

PacificSource values the diversity of our community, including those we hire and serve. We are committed to creating and fostering a work environment in which individual differences and diversity are appreciated, respected and responded to in ways that fully develop and utilize each person’s talents and strengths.

This position is accountable for the Provider Network department’s core operational, data, and systems functions. This role will oversee Provider Network divisions including Provider Relations, Provider Data Management, Credentialing, and provider platform interoperability.

This position leads both department-specific and cross departmental planning and execution efforts, to maintain high levels of performance in enterprise level and Provider Network level key performance indicators.

This position is responsible for all lines of business (Medicaid, Medicare, Commercial) and leads in strong alignment with the company’s strategic plan, vision, and values.

Essential Responsibilities: Guide strategic initiatives for the Provider Network Operations division, including network setup and maintenance, provider data integrity, provider education and service, contract implementation performance, provider-related claims, provider setup and audits, corrective action plan assessment and closure, and provider directory accuracy improvements.

Collaborate with Provider Reimbursement Insights and Analytics Team to ensure success in meeting objectives. Develop, direct and execute efforts to meet Credenti