Provider Operations Analyst II (Health Plan/Provider Data Experiencr)
Budget / Salary$62,700–100,400
TypeFull-time job
LocationUnited States
Posted4 hours ago
Job Summary:
The Provider Operations Analyst II is responsible for assimilating large quantities and/or complicated data into meaningful formats for tracking and status requirements.
Essential Functions:
Develop queries to identify and quantify provider data issues within the organization and assist in the development plans to resolve data issues
Provide operations teams; Contracting, Credentialing, Data Load, Directories, and Pended Claims with analysis and oversight for all provider data, workflows and processes
Act as Subject Matter Expert (SME)/Business Analyst/Data Analyst for Provider Operations team on various initiatives/special projects
Work cross functionally with Claims, Configuration, Market Reps, and Provider Operations to integrate business processes and workflows
Identify, develop, and implement reporting and/or business processes to ensure adherence to data quality, operational excellence, regulatory and compliance requirements
Develop and monitor daily metrics for staff quality, productivity, making recommendations for change as needed
Manage and conduct root cause analysis for high-level escalations that involve intensive research and resolution
Manage special projects through to resolution that may involve high dollar unpaid claims, risk of state complaint, risk of provider refusing to serve CareSource member(s), or risk of not meeting compliance requirements
Develop, document and perform testing and validation as needed for process and system changes
Serve as a primary point of contact for vendors and business partners that are sending and receiving CareSource provider data
Submit appropriate requests through the operations workflow to make updates on provider data
In collaboration with Talent Development, develop and present training modules and responsible to present to staff as needed
Perform any other job duties as requested
Education and Experience:
Bachelor’s Degree or equivalent years of relevant work experience is required
A minimum of three (3) years of health care or managed care experience is required
Experience working on a Claims systems, preferably Facets, preferred
Experience in provider relations, contracting, onboarding, credentialing, directories, pended claims, or configuration is highly preferred
Competencies, Knowledge and Skills:
Overall knowledge and understanding of one or more key provider systems, including Choreo/Contract Manager, Cactus and Facets.
Ability to manage multiple initiatives exhibiting excellent organizational and collaboration skills
Ability to effectively interact with all levels of management within the organization and across multiple organizational layers
Demonstrates excellent analysis and supporting technical skills to include SQL/Access capabilities
Time management skills, ability to develop, prioritize and accomplish goals with a sense of urgency
Ability to multi-task and remain flexible during organizational and/or business changes
Exceptional communication (verbal and written), facilitation and presentation skills
Strong interpersonal, leadership and relationship building skills
Critical listening, thinking, and problem resolution skills
Customer service oriented
Ability to understand workflows, process improvement, and work with Leaders to implement required changes
Proficient in data analysis
Advanced MS Excel, PowerPoint, and Word skills
Licensure and Certification:
None
Working Conditions:
General office environment; may be required to sit or stand for extended periods of time
May be required to travel, estimated at less than 10%
Compensation Range:
$62,700.00 - $100,400.00CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type (hourly/salary):
SalaryOrganization Level Competencies
Fostering a Collaborative Workplace Culture
Cultivate Partnerships
Develop Self and Others
Drive Execution
Influence Others
Pursue Personal Excellence
Understand the Business
This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.
Brand=CareSourceOriginally posted on Himalayas
The Provider Operations Analyst II is responsible for assimilating large quantities and/or complicated data into meaningful formats for tracking and status requirements.
Essential Functions:
Develop queries to identify and quantify provider data issues within the organization and assist in the development plans to resolve data issues
Provide operations teams; Contracting, Credentialing, Data Load, Directories, and Pended Claims with analysis and oversight for all provider data, workflows and processes
Act as Subject Matter Expert (SME)/Business Analyst/Data Analyst for Provider Operations team on various initiatives/special projects
Work cross functionally with Claims, Configuration, Market Reps, and Provider Operations to integrate business processes and workflows
Identify, develop, and implement reporting and/or business processes to ensure adherence to data quality, operational excellence, regulatory and compliance requirements
Develop and monitor daily metrics for staff quality, productivity, making recommendations for change as needed
Manage and conduct root cause analysis for high-level escalations that involve intensive research and resolution
Manage special projects through to resolution that may involve high dollar unpaid claims, risk of state complaint, risk of provider refusing to serve CareSource member(s), or risk of not meeting compliance requirements
Develop, document and perform testing and validation as needed for process and system changes
Serve as a primary point of contact for vendors and business partners that are sending and receiving CareSource provider data
Submit appropriate requests through the operations workflow to make updates on provider data
In collaboration with Talent Development, develop and present training modules and responsible to present to staff as needed
Perform any other job duties as requested
Education and Experience:
Bachelor’s Degree or equivalent years of relevant work experience is required
A minimum of three (3) years of health care or managed care experience is required
Experience working on a Claims systems, preferably Facets, preferred
Experience in provider relations, contracting, onboarding, credentialing, directories, pended claims, or configuration is highly preferred
Competencies, Knowledge and Skills:
Overall knowledge and understanding of one or more key provider systems, including Choreo/Contract Manager, Cactus and Facets.
Ability to manage multiple initiatives exhibiting excellent organizational and collaboration skills
Ability to effectively interact with all levels of management within the organization and across multiple organizational layers
Demonstrates excellent analysis and supporting technical skills to include SQL/Access capabilities
Time management skills, ability to develop, prioritize and accomplish goals with a sense of urgency
Ability to multi-task and remain flexible during organizational and/or business changes
Exceptional communication (verbal and written), facilitation and presentation skills
Strong interpersonal, leadership and relationship building skills
Critical listening, thinking, and problem resolution skills
Customer service oriented
Ability to understand workflows, process improvement, and work with Leaders to implement required changes
Proficient in data analysis
Advanced MS Excel, PowerPoint, and Word skills
Licensure and Certification:
None
Working Conditions:
General office environment; may be required to sit or stand for extended periods of time
May be required to travel, estimated at less than 10%
Compensation Range:
$62,700.00 - $100,400.00CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type (hourly/salary):
SalaryOrganization Level Competencies
Fostering a Collaborative Workplace Culture
Cultivate Partnerships
Develop Self and Others
Drive Execution
Influence Others
Pursue Personal Excellence
Understand the Business
This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.
Brand=CareSourceOriginally posted on Himalayas
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