What are the responsibilities and job description for the Provider Data Quality Admin (Hybrid - Troy, MI) - Health Alliance Plan position at Health Alliance Plan?
General Summary
The Provider Data Quality Admin is responsible for process oversight, planning, implementation, and coordination of the applications within the Provider Network Management department, as it relates to the integrity of provider reporting and provider data. The Provider Data Quality Admin must represent the Provider Network Management Department and seamlessly vacillate between projects with enterprise stakeholders on a variety of topics related to provider data, provider reporting and compliance.
Principle Duties And Responsibilities
Education/Experience Required
The Provider Data Quality Admin is responsible for process oversight, planning, implementation, and coordination of the applications within the Provider Network Management department, as it relates to the integrity of provider reporting and provider data. The Provider Data Quality Admin must represent the Provider Network Management Department and seamlessly vacillate between projects with enterprise stakeholders on a variety of topics related to provider data, provider reporting and compliance.
Principle Duties And Responsibilities
- Participate in or facilitate projects to represent Provider Network Management.
- Establish a comprehensive understanding of the lease networks and the impacts those contracts have on network compliance and reporting requirements.
- Develop and maintain methods to ensure service level agreements and key performance indicators are met and reported.
- Oversight of Provider Network Management customer relations management workflow compliance. This includes dashboard reporting, root cause analysis of process gaps and collaboration with other HAP business units to resolve.
- Gather, compile, analyze and interpret internal information to support all business functions using MS Access, Visio, MS Excel, Cognos, Geo Mapping and Network Adequacy software, HAP databases and other sources, while designing and generating ad hoc and standardized reports.
- Lead and coordinate Provider Network Management initiatives guiding multiple resources to design, execute, analyze, and interpret reports which draw upon multiple data sources, identify growth opportunities, competitor offerings and product performance.
- Oversight and monitoring compliance of the provider directory both static and dynamic.
- Act as a key liaison with lease networks and vendors to ensure seamless interactions and escalation.
- Act as a key liaison to either facilitate or develop department policies and procedures.
- Remain current with CMS, QHP, MDHHS, NCQA, OIG and other compliance requirements as it relates to Provider Network Management, ensuring all departmental policies remain compliant.
- Lead and coordinate compliance related reporting, including development of, and uploading documents to regulatory agencies including CMS, DIFS and MDHHS.
- Communicate insights, conclusions, and recommendations drawn from analysis in both written report and verbal presentation form, to direct business decision making.
- Facilitate responses to compliance related to process and reporting gaps, including development and oversight Corrective Action Plans.
- Identify potential product adjustments, additions and deletions based on provider network data and support the product management lifecycle through analyzing product membership and performance.
- Gather documentation from subject matter experts to produce NCQA qualitative and quantitative analysis for standards assigned to Provider Network Management.
- Act as a consultant on provider network adequacy, provider network disruption and geo access reports.
Education/Experience Required
- Associate degree in Computer Science, Business, or related field or an additional two (2) years of relevant and related experience may be considered in lieu of education requirement.
- Three (3) years of experience in using PC-based software packages including relational database systems, spreadsheet, word processing and statistical software.
- Minimum of two (2) years of experience in data analysis.
- Minimum of two (2) years of experience in the health insurance industry.
- Experience in provider data as it relates to maintenance, configuration, contracting and/or reporting.
- Demonstrated mathematical and analytical ability.
- Demonstrated organizational and time management skills.
- Knowledge of health care benefits, structures, and insurance procedures.
- Demonstrated knowledge of credentialing and contracting processes.
- Experience with database reporting tools. Proficiency in MS Office, specifically Excel and Access required.
- Understanding of healthcare industry and managed care concepts.
- Knowledge of Windows, Microsoft Excel and Word, Query Tools (COGNOS, etc.)
- A high level of human relations skills.
- Ability to adapt to a constantly changing environment.
- Demonstrated ability to coordinate and perform necessary follow-up for system related projects.
- Demonstrated ability to collect and prepare data for written/oral presentations.
- Demonstrated ability to conduct an oral presentation.
- Demonstrated ability to communicate effectively.
- Ability to interact with outside sources and maintain professional contacts.
- Must be able to work effectively with persons of varying position levels and diverse interests.
- Organization: HAP (Health Alliance Plan)
- Department: Provider Network Operations
- Shift: Day Job
- Union Code: Not Applicable
