Performance and Network Compliance Analyst

Emploi pas sur LinkedIn

🕒 il y a 19 jours

☕ Washington – Distant

☕ Washington – Remote

💵 $73 010 - $111 710 / an

⏰ Temps Plein

🟡 Intermédiaire

🟠 Senior

🚔 Conformité

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Community Health Plan of Washington

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501 - 1000 employés

Fondée en 1992

⚕️ Assurance santé

👥 B2C

Healthcare Insurance • B2C

Community Health Plan of Washington est un plan de santé à but non lucratif fondé en 1992 par les centres de santé communautaires de Washington. Il fournit des plans d'assurance pour Medicaid (Apple Health), Medicare Advantage, bi-éligibles, et individuels & familiaux à travers l'État de Washington. Il offre des services de gestion des soins, de santé comportementale, de soins virtuels, de soutien aux membres et de services communautaires, ainsi que des programmes tels que des récompenses, une assistance linguistique et des réseaux de prestataires pour répondre aux besoins des membres et de la santé communautaire.

Description

• 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.

🎯 Exigences

• 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.

🏖️ Avantages

• 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