UCare

CCO Provider Data Management Super User

Employer
UCare
Location
Minneapolis, Minnesota
Posted
Jun 23, 2022
Closes
Oct 08, 2022
Ref
3050
Category
Management
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 600,000 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 200 Workplace for 13 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.

CCO PROVIDER DATA MANAGEMENT SUPER USER

Work Location: Work from home, In the Office, or Office for Your Day

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 serve as the Subject Matter Expert when it comes to HealthRules supplier data and the supplier data management process. You will support the day-to-day work of the Provider Data Management Team to ensure alignment with configuration principles and support proper payment of claims ( in network and out of network providers). Monitor internal customer requests, questions, and escalations, making sure system updates are completed by team as needed. Monitor quality measurements and partner with Leadership on work assigned based on volume/capacity, adherence of service level agreements, and validation that proper workflow between departments is occurring. Serve as a liaison working with various stakeholders throughout the organization to improve the provider data management practices, processes, and governance. Plan and support training, onboarding, and coaching for functions related to supplier data management. Research complex system and claims issues related to supplier data to determine root cause, resolutions, process improvements, and automation opportunities for future prevention. Look for trends based on provider billing standards to prevent claims rejections and inaccurate pricing/adjudication.

• Serve as the main point of contact and liaison representing the Configuration Team regarding all things supplier data management in collaboration with business partners, data teams, and other technical teams.

• Create and monitor adherence to policies and procedures, standardization, processes, governance, and controls with oversight by the Configuration Supervisor.

• Identify team reporting needs (automated vs. ad-hoc), coordinate with appropriate fulfillment team, providing requirements, and tracking to completion.

• Provide support to team members responsible for supplier data management, analysts and auditors. Ensure the Configuration Supervisor is aware of any trends or issues that the team may be experiencing.

• Train, onboard and mentor provider data analysts and auditors on new functions, process optimizations, and corrective measures to ensure claims accuracy in collaboration with the Configuration Supervisor.

• Lead supplier data management efforts for Claims and EDI platform upgrades, including identifying and requesting enhancements, obtaining approval and prioritizing, resulting in process efficiency and automation.

• Collaborate with configuration analysts to ensure supplier data align with configuration principles and support the efficient and accurate configuration of supplier contracts. This includes understanding the relationship between supplier data and pricing/contract setup in HealthRules.

• Partner with Leadership to create quality and production standards, in addition to oversight of adherence of quality programs to support data integrity. Partner with Leadership and Quality Auditors to create strategy, framework, and standards for all quality related work.

• Act as liaison between configuration team and various stakeholders throughout the organization for data related functions, in addition to sending and replying to communications regarding provider setup to external and internal customers timely and accurately.

• Ensure department service level agreements (SLAs) are met and that work output and workflow processes are adhered to. Ensure the Configuration Supervisor is aware of SLAs.

• Responsible for planning and management of special projects related to supplier data management, as assigned by Leadership.

• Create and have oversight for dashboards related to provider data requests, trends, and volumes assisting Leadership in prioritization and work assignments.

• Use critical thinking to determine and resolve complex claims issues and escalations with incorrect suppliers, practitioner, and supplier locations information, working with applicable stakeholders for rectification.

• Other projects and duties as assigned.

Education

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

Required Experience

Five years' experience managing provider data for healthcare operations. Experience managing data/configuration and working with claims in the HealthRules Payor Application. Experience in coaching and training on operational processes. Experience with complex issue management, analysis and resolution.

Preferred Experience

Development of quality-based programs related to data integrity. Experience creating dashboards and reports for leadership. Claims analysis to determine data trends and resolve complex issues. Creation of process optimization for increased productivity.

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: 06/22/2022

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