Performance and Network Compliance Analyst

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🕒 Junho 6

☕ Washington – Remoto

☕ Washington – Remote

💵 $73.010 - $111.710 / ano

⏰ Tempo Integral

🟡 Pleno

🟠 Sênior

🚔 Conformidade

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Community Health Plan of Washington

SiteLinkedInTodas as Vagas

501 - 1000 funcionários

Fundada em 1992

⚕️ Seguro de Saúde

👥 B2C

Healthcare Insurance • B2C

O Community Health Plan of Washington é um plano de saúde sem fins lucrativos, fundado em 1992 pelos centros de saúde comunitários de Washington, que oferece planos de seguro Medicaid (Apple Health), Medicare Advantage, Dual-eligible e Individual & Family em todo o estado de Washington. Oferece gerenciamento de cuidados, saúde comportamental, atendimento virtual, apoio aos membros e serviços comunitários, além de programas como recompensas, assistência linguística e redes de provedores para atender às necessidades de saúde dos membros e da comunidade.

Descrição

• This position is responsible for coordination and execution of provider network regulatory deliverables and compliance activities, including oversight of reporting processes, submission timelines and regulatory requirements. • The role partners with internal stakeholders to ensure accurate, timely and compliant submissions, including Behavioral Health network reporting, performance improvement and regulatory readiness. • Performs daily troubleshooting to ensure and provide timely responses to agency inquiries and requests, coordinating with relevant departments and stakeholders for resolution of objections from regulatory entity. • Develops project status reports and business requirements for internal stakeholders on a regular basis. • Develops and maintains model to assess and monitor Community Health Plan network development strategies, ensuring alignment with organizational goals. • Collaborates with subject matter experts to track key performance indicators, identify trends and recommend interventions for network improvement. • Analyzes demographic and utilization data to support regulatory filings and identify opportunities for network expansion. • Sub-division coordination and planning of TEAMonitor narratives, supporting documentation, timelines, communications and QA processes. • Monitor Behavioral Health network and outreach in support of Quarterly HCA Provider Network Submission, to include regular review of geographic/service coverage of Behavioral Health Agencies. • Maintains Behavioral Health AADR process and project plan development quarterly in alignment with contract department review. • Develops of Mental Health Assessment utilizing claims information and compilation of data sets to support analysis. • Coordinates resolution of contracting provider data gaps impacting regulatory submissions, ensuring reliability, completeness, consistency and compliance. • Develops and maintains processes to track and manage regulatory deliverables, resolving issues to ensure accuracy of narratives and data submissions, to include TEAMonitor coordination and HCA contract reviews. • Collaborates across departments and teams to initiate and deliver projects that advance network strategy and fosters interdepartmental partnerships.

🎯 Requisitos

• Have an associate degree or an equivalent combination of education and highly relevant experience required. • Have a minimum of three (3) years’ experience working with health care professionals. • Have a minimum of three (3) years’ experience in managed care, required. • Have a minimum of two (2) years of experience managing large amounts of complex data and reconciling data output. • Have knowledge of Centers for Medicare & Medicaid Services (CMS), Healthcare Authority (HCA), Office of the Insurance Commissioner (OIC) Washington State managed care network regulatory requirements. • Have experience in project coordination and office support, preferred.

🏖️ Benefícios

• Medical, Prescription, Dental, and Vision • Telehealth app • Flexible Spending Accounts, Health Savings Accounts • Basic Life AD&D, Short and Long-Term Disability • Voluntary Life, Critical Care, and Long-Term Care Insurance • 401(k) Retirement and generous employer match • Employee Assistance Program and Mental Fitness app • Financial Coaching, Identity Theft Protection • Time off including PTO accrual starting at 17 days per year. • 40 hours Community Service volunteer time • 10 standard holidays, 2 floating holidays • Compassion time off, jury duty