Job Overview:
- Ensure the Provider Operations Department adheres to the guidelines set forth by accreditation and regulatory organizations (i.e. NCQA, DMAS, CMS).
- Supports resolution of problems with Centers for Medicare and Medicaid, and related regulatory organizations.
- Participates in internal compliance audits for the department.
- Assists with the auditing functions related to the fee schedule and vendor setup through internal reporting tools and monitors all payments and payment methodologies
- Develops and enhances existing corporate metrics for the department.
- Assists the liaison for the provider community when appropriate, including involvement in closing and reassigning member panels, termination/deactivation of contracted providers, researching and resolving provider claim issues
- Assists with the development of internal policies and procedures
- Works closely with the implementation team to validate provider mapping and contract assignment for all lines of business.
- Serves as subject matter expert in regard to provider data setup
- Advocate for data quality and process efficiency
- Develops and executes test cases and has an understanding of system functionality as it relates to provider data and reimbursements based on contractual agreements.
- Trains and develops other analysts in the department on processes, data, and reporting.
- Develops cost analysis for contracting initiatives.
- Serves as the analyst team lead in delegating and mentoring.
- Manages internal, cross-departmental, and third-party vendor team projects.
Job Type: Contract
Pay: $68,446.64 - $82,430.37 per year
Schedule:
- 8 hour shift
- Monday to Friday
Work Location: Remote