Provider Network Analyst Senior
7 days left
- Employment Status
- Full Time
Health Care that Starts with You!
Join a truly mission-driven organization! Independent, nonprofit UCare is recognized as one of the Minnesota's leading health plans. We provide more than 225,000 members across Minnesota and western Wisconsin with the health coverage plans and services they need to maintain and improve their health. The innovative coverage we create makes a difference for Medicare-eligible individuals, individuals and families enrolled in Minnesota Health Care Programs, such as MinnesotaCare and Medical Assistance, and disabled adults with special health care needs. UCare is growing in size, membership, products, geographic coverage, and employees. We're an organization that's going places. Be part of a team that cares about you, be part of UCare.
ABOUT UCAREAt UCare, we deliver high-quality health coverage and services to help members of all ages maintain and improve their health. It's a big job that takes innovative ideas, strategic partnerships, and a commitment to doing the right thing. Above all, it takes a compassionate team that is dedicated to making a real difference in the lives of our members and our communities. WORKING AT UCAREWorking at UCare is more than just a career; it's a mission. A mission that defines us as professionals, unites us as an organization, and shapes how we interact with our members and each other. Our values of integrity, community, quality, flexibility, and respect permeate every aspect of our organization - from who we are and how we act, to what we do and how we do it. We owe our continued success to our employees who proudly embody our mission and values in everything they do. PROVIDER NETWORK ANALYST SENIOR Position DescriptionThis position is responsible to create provider network reports for various regulators (DHS, CMS, and MDH). Create PCNLs (Primary Care Network Listing), Provider Directories and policies; conduct audits of provider demographic information. Collaborate with Government Programs on all regulatory audits and RFPs related to provider network, access & availability ensuring contractual requirements are met. Specific duties and responsibilities include: Monitor network access and availability through generation of GeoNetwork / Quest Analytics maps and reports. Ensure contractual compliance as defined within current department timelines and standards. Respond to and produce ad-hoc GeoNetwork / Quest Analytics maps as reports as assigned.Create PCNLs (Primary Care Network Listing), Provider Directories and policies; conduct audits of provider demographic information. Collaborate with Government Programs on all regulatory audits and RFPs related to provider networks, access & availability ensuring contractual requirements are met. Conduct monthly audit of credentialing application and delegated source data for provider directories and online display. Work interdepartmentally to develop and maintain criteria for provider set up in credentialing tool.Oversee PCNL and Provider Directory productions by monitoring Provider Data accuracy, adherence to deadlines, and effectiveness of DirectoryExpert. Develop and maintain procedures and/or policies related to accurate production of PCNLs and Directories. Ensure compliance with State and Federal regulations and contract requirements.Prepare the monthly Network files for DHS. Initiate provider data extracts from multiple sources, complete file build, audit and coordinate with other departments as necessary. Collaborate with team to coordinate provider network response to CMS expansion applications, HSD/Health System Delivery tables, DHS RFP's and MDH audits.Audit UCare's Find A Doc website to ensure accuracy of provider data display and other functionality (i.e., provider search ).Conduct annual network validation through partnership with the provider community. Preparation and distribution of validation files in a format accepted by the provider community at large. Ensure system updates are completed in a timely manner.Coordinate and respond to inquiries both internally and externally surrounding Provider Data as it is configured in source systems and displays in Provider Directories.EducationBachelor's degree or equivalent in health care management or related field preferred; demonstrated work experience may be considered in lieu of degree.Required ExperienceFive years of experience in a health delivery setting, such as physician group practice, health insurance, HMO or community service agency. Three years of experience related to Health Plan operations. Strong software skills in SQL, MS Access & Excel. Spatial reasoning and geography skills.Preferred ExperienceExperience with Analytical problem solving. Project management and data validation. Experience with GeoAccess / Quest Analytics. Cactus and Amisys or credentialing and claims platform experience a plus. Proficient Microsoft software skills THE UCARE DIFFERENCEUCare is proud to be a recognized Star Tribune Top Workplace for the 8th consecutive year. As a part of our collaborative team, you'll experience the rewards that come with helping others and seeing the positive results of your hard work. We value and respect each individual's ideas and contributions, and give you the freedom to grow both personally and professionally. We are centrally located, and offer onsite education, equipment and wellness resources, a myriad of volunteer activities, and a number of other rewards. If you're looking for a welcoming environment that celebrates what you have to offer, helps you build on your strengths, and gives you the opportunity to truly make a difference, we invite you to apply. As an Equal Opportunity/Affirmative Action Employer, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve.
Enter a highly collaborative environment where people are truly engaged, and feedback is valued. You'll enjoy a competitive salary and benefits, as well as a host of other perks, including a nationally recognized wellness program, and a bright, open, award-winning office space in Northeast Minneapolis just minutes from major freeways and retail centers.
At UCare, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve.