Provider Operations Analyst II (Health Plan/Provider Data Experiencr)

CareSource; Kentucky; Hybrid; USD 63,000 - 100,000; Full time

Job summary

CareSource is seeking a Provider Operations Analyst II to transform large, complex data into actionable insights for tracking and status reporting.

You will develop queries, support multiple provider-data workflows, and serve as SME for operations initiatives across Claims, Credentialing, Directories, and Pended Claims. A strong data-analysis background and experience with Facets are preferred.

Qualifications

• Bachelor's Degree or equivalent years of relevant work experience required.
• Minimum three (3) years of health care or managed care experience required.
• Experience with provider data, data governance or related processes preferred.

Responsibilities

• Develop queries to identify provider data issues and assist in remediation plans.
• Provide analysis and oversight for provider data workflows and processes.
• Act as SME/BA/Data Analyst for Provider Operations on initiatives and projects.
• Work cross functionally with Claims, Configuration, Market Reps, and Provider Operations to integrate workflows.
• Identify, develop, and implement reporting and business processes to ensure data quality and regulatory compliance.

Skills

SQL

Data analysis

Excel

PowerPoint

Communication

Cross-functional collaboration

Education

Bachelor's Degree or equivalent

Tools

Facets

SQL

Access

Job description

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 - $100,400.00 CareSource 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):

Salary

Organization 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.

#LI-SD1 Brand=CareSource

The CareSource mission is known as our heartbeat.

Just as we support our members to be the best version of themselves, our employees are driven by our mission to create a better world for members, stakeholders and providers.

We are difference-makers who combine compassionate hearts with our unique business expertise to make every opportunity count.

Each claim, each phone call, each consumer-centric decision is a chance to change the world for one member, and our employees look for ways to do that every day.

The challenge is, there is no one right way to be the difference and we're looking for people like you that will rewrite that definition every day.

We do what it takes to form creative solutions that make our community and the world just a little better.

Discover what it means to be #UniquelyCareSource.