Manager, Provider File Maintenance in Birmingham

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Job DescriptionJob Description

Manager, Provider File Maintenance (PFM)

Location: Birmingham, AL

Why VIVA HEALTH?

VIVA HEALTH, part of the renowned University of Alabama at Birmingham (UAB) Health System, is a health maintenance organization providing quality, accessible health care. Our employees are a part of the communities they serve and proudly partner with members on their healthcare journeys.

VIVA HEALTH has been recognized by Centers for Medicare & Medicaid Services (CMS) as a high-performing health plan and has been repeatedly ranked as one of the nation's Best Places to Work by Modern Healthcare.

Benefits

• Comprehensive Health, Vision, and Dental Coverage
• 401(k) Savings Plan with company match and immediate vesting
• Paid Time Off (PTO)
• 9 Paid Holidays annually plus a Floating Holiday to use as you choose
• Tuition Assistance
• Flexible Spending Accounts
• Healthcare Reimbursement Account
• Paid Parental Leave
• Community Service Time Off
• Life Insurance and Coverage
• Employee Wellness Program
• Training and Development Programs to develop new skills and reach career goals
• Employee Assistance Program

See more about the benefits of working at Viva Health - https://www.vivahealth.com/careers/benefits

Job Description

The Provider File Maintenance (PFM) Manager leads a team responsible for maintaining provider records, ensuring data quality, supporting credentialing, and network operations, and coordinating with internal and external stakeholders to meet compliance, operational, and reporting requirements. This role ensures provider information is updated timely and accurately to support claims processing, directory accuracy, regulatory obligations, and member experience.

Key Responsibilities

• Manage day-to-day activities of the PFM team to ensure provider information is accurately and timely maintained.
• Monitor and assign workload, set priorities, and ensure turn-around time and quality targets are met.
• Work with provider relations, network development, compliance, credentialing, accounting, and/or claims departments to resolve provider data discrepancies.
• Establish and oversee quality control processes to ensure data integrity and regulatory compliance including, but not limited to, Centers for Medicare & Medicaid Services (CMS), state regulations, and provider directory accuracy requirements.
• Participate in system enhancements, testing, upgrades, and integration projects involving provider data.
• Support root-cause analysis for data-related issues and implement solutions to prevent recurrence.
• Respond to escalations related to provider data issues affecting claims processing, directory accuracy, and member/provider experience.
• Train, coach, and mentor staff to promote excellent performance and growth.
• Generate and analyze reports on team performance, error rates, and turnaround times.
• Review work processes to identify opportunities and implement improvements for handling or maintaining provider information.

REQUIRED QUALIFICATIONS:

• Bachelor’s Degree or equivalent work experience in a related field
• 5 years’ experience with managed care and current core computer system
• 2-3 years in a managerial or supervisory role
• Excellent written and verbal communication skills
• Detail-oriented with excellent problem-solving skills
• Ability to multi-task and supervise multiple projects simultaneously
• Ability to interact with all departments and levels of management in a professional manner

QUALIFICATIONS:

• Bachelor's Degree
• Experience in PowerSTEPP
• Proficient in the Microsoft Office suite of products

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