Ecommerce Provider Data and Compliance Specialist

HealthPartners/GHI; BLOOMINGTON (MN); On-site; USD 55,000 - 75,000; Full time

Job summary

HealthPartners is seeking an Ecommerce Provider Data and Compliance Specialist to promote and support regulatory compliance activities within the Provider E-Commerce and Operations area. You will participate in trainings, work groups, and tracking regulatory activities to ensure provider data integrity and compliance across systems.

The role emphasizes collaboration, process improvement, and timely communication with internal staff and regulators, including CMS, DHS, NCQA, and MDH, to support

Qualifications

• Four year degree in a related field or two years related work experience in lieu of degree.
• Two years work experience in a related field (compliance, electronic commerce, contracting, business or system analysis, customer service, training, project management, health care operations).
• Intermediate Microsoft Excel skills.
• Proven organizational skills.
• Ability to work independently.
• Ability to multi-task in a fast paced environment.
• Strong interpersonal skills.
• Demonstrated analytical and problem solving skills.
• Demonstrated ability to take responsibility for performance and attitude on the job.
• Demonstrated ability to work collaboratively with others both inside and outside the organization.

Responsibilities

• Promote and support compliance activities within Provider E-Commerce and Operations.
• Coordinate resolution to operational issues and support trainings.
• Track and monitor regulatory activities with regulators such as CMS, DHS, NCQA, and MDH.
• Create, review, revise, maintain, and track internal provider policies and procedures.
• Interact with staff to communicate provider terminations and regulatory requirements.
• Assist with business continuity and disaster recovery plans and tests.

Skills

Excel

Organizational skills

Independent work

Multi-tasking

Interpersonal skills

Analytical thinking

Collaboration

Problem solving

Education

Bachelor's degree in a related field

Job description

HealthPartners is hiring a Ecommerce Provider Data and Compliance Specialist. This role promotes and supports compliance related activities within our division and within the organization. THey support and coordinate resolution to operational issues, participate in conducting trainings, participate in work groups, and track and monitor regulatory activities.

ACCOUNTABILITIES:

1. Understands and support HealthPartners Provider Electronic Commerce and Operations options to effectively promote compliance with regulatory areas.
2. Understands and supports monitoring of regulatory activities as required by regulatory agencies such as CMS, DHS, NCQA, and MDH.
3. Interact with other departmental staff on individual providers, clinic and facility terminations to ensure members are notified in a timely manner as specified by regulators.
4. Participates in the creation, review, revision, maintenance and tracking of internal and provider administrative policies and procedures.
5. Coordinates provider communications as requested on behalf of Provider E-Commerce and Operations including tracking of required regulatory communications
6. Assists with product and delivery network set-up in CPN, tracking and documentation upon request.
7. Perform audits on CPN transactions using audit reports and completed provider or delivery network alerts.
8. Assist in testing enhancements to the CPN application.
9. .Participates in the development and implementation of process improvements.
10. Serves as a liaison with internal staff as needed.
11. Supports other business staff in ongoing service needs.
12. Participates in and assists with business continuity and disaster recovery plans, tests and revisions.

13. Performs other duties as assigned.

REQUIRED QUALIFICATIONS:

• Four year degree in a related field (customer service, training, project management, business, or health care) or two years related work experience in lieu of degree.
• Two years work experience in a related field (compliance, claims, electronic commerce, contracting, business or system analysis, customer service, training, project management, health care operations).
• Intermediate Microsoft Excel skills.
• Proven organizational skills.
• Ability to work independently.
• Ability to multi-task in a fast paced environment.
• Strong interpersonal skills.
• Demonstrated analytical and problem solving skills.
• Demonstrated ability to take responsibility for performance and attitude on the job.
• Demonstrated ability to work collaboratively with others both inside and outside the organization.
• Ability to work well with broad and different audiences.

PREFERRED QUALIFICATIONS:

• Training experience, preferably in managed care and/or health care operations.
• Experience in working in a managed care organization or in a provider office.
• Project coordination skills.