UCare

Provider Data Compliance Analyst

7 days left

Employer
UCare
Location
Minneapolis, Minnesota
Posted
Oct 05, 2021
Closes
Nov 01, 2021
Ref
2595
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

UCare offers Medicare, Medicaid, Individual and Family health plans - powered by the hardest working people in the industry. Our people powered teams de-complicate, advocate and always go the extra mile to help our members. We serve with integrity, compassion and commitment to do right by members, providers and government partners. Above all, we come to work excited to provide members a path for the best health of their lives.

WORKING AT UCARE

Working at UCare is more than 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. Employees join UCare and stay because of the opportunity to have a purpose-driven job.

Our strong culture has established UCare as a Star Tribune Top 150 Workplace for 12 consecutive years since the awards program began. It's a culture that embraces innovative ideas, strategic partnerships, and exemplary customer and provider experiences. Working at UCare is being a part of a people powered team dedicated to making a real difference in the lives of our members and communities.

PROVIDER DATA COMPLIANCE ANALYST

Work Location: Work from home, in the office or hybrid (in the office 3 or more days per week)

The health and safety of our employees, members, providers, and our community is our highest priority. Therefore, all new employees are expected to be fully vaccinated against COVID-19 prior to starting at UCare, subject to limited exceptions such as for a sincerely held religious belief or for medical reasons.

Position Description

This position is responsible to analyze, monitor, and manage UCare Provider Network data. Evaluate state and federal regulatory requirements and aid in administrating UCare's provider data compliance program. Assess and communicate regulatory changes to business partners. Identify noncompliant providers based on federal and state sanction lists. Collaborate with business partners and key stakeholders to develop and refine processes to support corporate, industry and government provider data standards. Inspect processes and lead gap remediation efforts.

• Manage and oversee data from UCare's third party quality management vendor to ensure timely processing of reports.

• Partner with UCare's Special Investigations Unit (SIU), Compliance and Legal teams to ensure all network providers are in compliance with state and federal laws. Obtain knowledge of provider adverse actions from state and federal agencies.

• Participate in discussions related to Centers for Medicare (CMS) and Minnesota Department of Human Services (DHS) regulations and requirements to ensure provider data compliance; including monitoring lists such as Medicare Opted Out, NPI Deactivation and CMS preclusion.

• Monitor provider data identifiers on Minnesota State Department of Human Services (DHS) files (PECD) and take appropriate actions to ensure correct setup based on state and federal requirements.

• Monitor the PECD and Personal Care Attendant (PCA) files to ensure proper steps are taken for providers that are non-payable.

• Send timely notifications to business stakeholders to update appropriate data processing systems. Conduct audit to ensure updates are completed accurately and within established service levels.

• Analyze provider data to ensure accuracy and support auditing processes. Maintain knowledge of provider setup functions in Amisys and HealthRules.

• Assist with updating provider data in Amisys and HealthRules to ensure proper reimbursement or payment suspensions.

• Coordinate meetings with internal business partners to identify and document process requirements. Conduct research as needed to ensure processes are compliant and properly documented.

• Other projects and duties as assigned.

Education

Bachelor's degree: demonstrated experience may be considered in lieu of degree.

Required Experience

Five years of experience with health plan provider data. Microsoft Office proficient with intermediate Excel and/or database experience.

Preferred Experience

Prior Medicaid/Medicare/Commercial insurance regulatory experience. Experience with auditing, analyzing, and improving business processes. Proficient with Microsoft SQL. Experience with Amisys and/or HealthRules. Experience with Streamline Verify.

THE UCARE DIFFERENCE

The UCare difference is our people power - employees actively working on the behalf of our members to get them access to the health care they need. We value and respect each individual's ideas and contributions, and provide the freedom to grow both personally and professionally. We are centrally located, and offer onsite education, equipment and wellness resources, and a myriad of volunteer activities. If you're looking for an inclusive environment that celebrates your people power, 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.

JOB POST DATE: 10/04/2021

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