Practice Director

Job Title: Director PDM/PNO (U.S. Healthcare Practice Office Specialist)

Reporting To: SVP Practice

Work Location: AMR Tech Park , Bengaluru I (Work from Office)

Role Type: Individual Contributor

Role Summary

The Director Provider Data Management (PDM) is an individual contributor role responsible for supporting operational excellence while contributing to the development of new solutions and services within the Provider Data Management line of business.

This role demands deep domain expertise in Provider Data Management and Credentialing operations, along with proven experience in driving cost optimization and leading transformation initiatives. The incumbent will ensure data integrity, regulatory compliance, and streamlined processes to support accurate and efficient provider data management for health plan clients.

Key Responsibilities

Domain Leadership & Strategic Awareness

• Demonstrate strong expertise in the PDM domain, with a comprehensive understanding of delivery and solution frameworks.
• Drive innovative strategies to enhance operational efficiency, effectiveness, and business outcomes.
• Stay abreast of industry trends, emerging technologies, and best practices in provider data management, proactively identifying opportunities for continuous improvement.

Provider Data Management

• Lead and manage initiatives related to provider data, including system enhancements, process optimization, and data migration.
• Oversee provider credentialing and enrollment processes, ensuring accurate verification of licenses, certifications, and accreditations.
• Collaborate with technology teams to optimize system performance and usability.
• Develop and present analytical reports on provider data metrics, trends, and performance indicators.

Data Governance

• Establish and implement robust data governance frameworks to ensure consistency, accuracy, and standardization of provider data.
• Define data quality benchmarks and monitor data completeness and accuracy across systems.

Stakeholder Management

• Partner with internal stakeholders such as contracting, network management, claims, and operations to ensure data accuracy and alignment with business needs.
• Resolve provider data-related issues effectively and ensure seamless cross-functional collaboration.
• Work closely with Technology, CRM, Operations, and Sales teams to drive transformation initiatives and identify opportunities for service expansion and cross-selling.

Compliance & Regulatory Adherence

• Ensure adherence to all applicable healthcare regulations, including HIPAA, HITECH, NSA, and ACA.
• Develop and maintain policies and procedures to support compliance, conducting regular audits to identify and mitigate risks.
• Stay updated on regulatory changes and drive awareness and training across teams to ensure ongoing compliance.

Performance Reporting & Continuous Improvement

• Define and track KPIs for provider data management operations, focusing on accuracy, turnaround time, and efficiency.
• Deliver regular performance reports and actionable insights to leadership.
• Continuously identify process improvement opportunities and implement best-in-class practices.

Skills & Competencies

• Strong collaboration and stakeholder influencing skills within a metrics-driven environment.
• Proven leadership capabilities with experience in driving high performance and operational excellence.
• Excellent analytical, problem-solving, and decision-making skills.
• Strong communication and interpersonal abilities with the capacity to engage effectively across functions.
• Deep understanding of regulatory compliance requirements in U.S. healthcare.
• Proficiency in PDM platforms, data analysis tools, and Microsoft Office Suite.

Education & Experience

• Bachelors degree in Healthcare Administration, Business Administration, or a related field (Masters preferred).
• 1418+ years of overall U.S. healthcare experience, with 810 years of specialized experience in Provider Data Management.
• Strong expertise in provider lifecycle management, including recruitment, data setup, validation, credentialing, and re-credentialing.
• Experience in provider outreach operations for data validation.
• Comprehensive knowledge of credentialing and enrollment processes, including verification of licenses, certifications, and accreditations in compliance with regulatory standards.