UCare

Provider Network Analyst Sr.

7 days left

Employer
UCare
Location
Minneapolis, Minnesota
Posted
Jun 14, 2019
Closes
Jul 24, 2019
Ref
1630
Category
Healthcare
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.

Rewards

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.

www.ucare.org/careers/

EOE/AA

ABOUT UCARE

At 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 UCARE

Working 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 Description

This position is responsible to create the provider network reports for various regulators (DHS, CMS, and MDH). Responsible for Provider Directory production protocol, regulatory Provider Directory model compliance and Provider Data accuracy oversight. Collaborate with Government Programs on all regulatory audits and RFPs related to provider network, access & availability.

• Monitor network access and availability through generation of Quest Analytics maps and reports. Ensure contractual compliance as defined within current department timelines and standards. Respond to and produce ad-hoc Quest Analytics maps as assigned. Support other network reporting requests relating to UCare needs and occasional compliance reviews. Research of provider availability through internal and publicly available data sources.

• Collaborate with internal materials team to produce Provider Directories and policies; conduct audits of provider demographic information. Develop and refine data validation and network reconciliation process.

• Conduct ongoing audits of credentialing data and delegated source data for provider directories and online display. Assist with Data Reporting Project to ensure ongoing accurate build out of data reporting layer.

• Oversee Provider Directory productions by monitoring Provider Data accuracy, adherence to deadlines, and effectiveness of production process. Develop and maintain procedures and/or policies related to accurate production of Directories. Ensure compliance with State and Federal regulations and contract requirements.

• Support the preparation of 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 the Provider Data and Network Analytics team to coordinate provider network response to CMS HSD/Health System Delivery tables, DHS RFP's and MDH Network Adequacy audits.

• Audit UCare's Provider Search website to ensure accuracy of provider data display and other functionality. Work cross departmentally to ensure proper data sourcing policies.

• 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.

• Other projects and duties as assigned.

Education

Bachelor's degree or equivalent in health care management or related field preferred; demonstrated work experience may be considered in lieu of degree.

Required Experience

Three years of experience in a health delivery setting, such as physician group practice, health insurance, HMO or community service agency. Strong software skills with T-SQL, MS Access & Excel. An understanding of basic database architecture. Spatial reasoning and geography skills.

Preferred Experience

Experience with Analytical problem solving, Project management and data validation. Experience with Quest Analytics. Cactus and Amisys or credentialing and claims platform experience a plus. Proficient Microsoft software skills

THE UCARE DIFFERENCE

UCare is proud to be a recognized Star Tribune Top Workplace for the 10th 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.

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