Hiring: Director of Provider Operations Company: HealthPartners Location: Bloomington, MN Job Posted Time: 2026-09-16 11:50:46 Employment Type: Contract Target Skills & Keywords : HIPAA, Medicaid, Medicare, Microsoft Excel, Project Management, Provider Enrollment, R, Regulatory Compliance, SQL, Six Sigma, Stakeholder Management About the job Experience: •7 years experience in health care or insurance industry, health-related project management, provider data/operations or provider network management •5 years in a leadership or management role •10+ years of experience in provider operations or network management with 5+ years in a senior leadership role overseeing multi-line health plan operations (Commercial, Medicare, Medicaid) Required Skills: •Develop and execute a comprehensive provider operations strategy aligned with organizational goals and regulatory requirements. •Partner with IT and other health plan system owners to develop an integrated enterprise-wide provider data platform. •Lead cross-functional initiatives to enhance provider data accuracy and implement cost effective enrollment processes to facilitate quick provider on-boarding, claims submissions and provider payments. •Oversee contracted provider end-to-end provider data lifecycle including intake of roster and enrollment forms, maintenance of provider data, network participation management, clearinghouse, EFT and web portal enrollment •Oversee vendor relationships and performance, ensuring accountability and ROI. •Ensure adherence to federal and state regulations, including CMS and Medicaid guidelines. •Partner cross-functionally with Provider Relations & Network Management, Legal, Compliance, and Claims teams to mitigate risk and ensure audit readiness. •Leverage analytics to identify trends, root causes, and opportunities for improvement. Qualifications: •Bachelor degree in health care, business, public administration, IT, project management or related field •In-depth knowledge of health plan operation workflows from provider contracting to enrollment to claims processing and payments. •Solid functional working knowledge of regulatory requirements for Medicare, Medicaid, and Commercial lines of business. •Proven ability to lead cross-functional teams and manage complex projects. •Proficiency in data analysis and reporting tools (e.g., Excel, SQL, PowerBI). •Excellent communication, negotiation, and stakeholder management skills. •Demonstrated capacity to work in a fast-paced, matrixed environment with competing priorities. •Strong interpersonal and collaborative skills to lead and influence teams at all levels of the organization. •Solid analytical, project and financial management skills. •Demonstrated capacity to offer creative, cost-effective alternatives and options to solve problems and meet customer needs. Interested candidates, please apply directly through the job posting on company's career page or try via AI auto apply on this platform. Don't miss this opportunity to join a forward-thinking team!