Provider Data Supervisor

The Provider Data Supervisor is the manager responsible for the strategy, operations, and outcomes of the Provider Data Management function supporting the World Trade Center Health Program (WTCHP).

This role leads a team of Provider Data Representatives to maintain accurate provider demographic, enrollment, credentialing, participation, and directory information across systems; oversees roster reconciliation; safeguards data quality that impacts claims adjudication; and drives continuous improvement and audit readiness.

The Supervisor partners closely with Provider Relations, Contracting, Credentialing, Claims Operations, and Compliance to ensure provider information is complete, accurate, timely, and aligned to organizational standards.

Key Outcomes & Success Metrics

• Directory accuracy & completeness: Meet internal standards and regulatory expectations; reduce member/provider complaints related to directory errors.
• Maintenance timeliness: Process provider updates, additions, terminations, and changes on time within SLAs; reduce backlog and cycle time.
• Data integrity: Improve audit scores; lower claims‑impacting data error rates; maintain accurate NPIs, TINs, specialties, practice locations, affiliations, licenses, EFT details.
• Roster reconciliation effectiveness: Validate rosters from healthcare delivery organizations across source systems; identify and correct discrepancies promptly to strengthen participation accuracy.
• Cross‑functional alignment: Reduce onboarding delays and enrollment exceptions through tight coordination with Credentialing, Contracting, Provider Relations, and Claims.
• Operational efficiency: Standardize procedures, leverage automation and dashboards, and demonstrate measurable gains in productivity and quality.

Essential Duties & Responsibilities

Leadership & Strategy

• Own the provider data management strategy and annual operating plan; translate organizational goals into targets, roadmaps, KPIs, and resource plans.
• Lead, coach, and develop Provider Data Representatives; set goals, conduct performance evaluations and coaching, and promote professional development.
• Establish governance for data standards, approvals, exception handling, and escalation pathways; define disciplined operating rhythms.

Provider Data Management & Lifecycle

• Oversee maintenance of provider demographics, participation, enrollment, credentialing attributes, and directory content across systems.
• Ensure timely processing of provider updates, new enrollments, terminations, and changes; validate records across operational systems to support accurate claims payment and directory publication.
• Manage data requirements across the provider lifecycle (onboarding, participation activation, recredentialing, termination) in partnership with Credentialing and Provider Relations.

Roster Reconciliation & Directory Accuracy

• Supervise routine reconciliation of provider rosters submitted by healthcare delivery organizations; validate against credentialing, enrollment, terms & conditions, claims, and directory data.
• Identify discrepancies affecting participation or operational performance; coordinate corrective actions internally and with provider organizations.
• Develop standardized reconciliation procedures, quality controls, duplicate/merge resolution rules, and steward a master “golden record.”

Cross‑Functional Collaboration

• Partner with Provider Network Team and Contracting to align data requirements with contracting terms, onboarding milestones, and provider communications.
• Collaborate with Credentialing to ensure records are complete and current; synchronize participation dates, required documents, and recredentialing cycles.
• Work with Claims Operations to resolve provider data discrepancies affecting reimbursement; support EDI/configuration updates and claims‑impact analyses.
• Participate in enterprise initiatives involving provider systems and operational improvements; lead provider data meetings and cross‑functional workgroups.

Risk, Compliance & Stakeholder Management

• Ensure compliance with organizational policies, privacy/security requirements, and applicable regulations impacting provider directories and data management; maintain audit‑ready documentation.
• Participate in internal audits and quality reviews; develop and execute corrective action plans addressing identified deficiencies.
• Communicate status, risks, and recommendations to executive stakeholders; prepare materials for business reviews and governance committees.

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