Job Summary:
The Provider Network Operations Analyst II executes small to medium scale project plans, business and data analysis, and provides specialized support of the LTSS & HCBS provider network and EVV compliance initiatives.
Essential Functions:
- Analyze data, workloads, and processes to enhance operations efficiencies in support of LTSS & HCBS providers.
- Identify trends and solutions to operational support and ensure provider adherence to regulatory and contractual requirements.
- Perform quality assurance reviews to ensure that provider information is loaded correctly, and contracting terms are accurately operationalized.
- Assist with research and resolution of provider inquiries and provide a professional and comprehensive response to providers and other stakeholders as required.
- Improve Electronic Visit Verification compliance rates for provider network
- Perform virtual initial onboarding and ongoing education to provider network.
- Manage online communications and optimize service delivery and provider experience.
- Assist with network adequacy requirements through analysis and service delivery resulting in provider retention.
- Responsible for understanding regulations changes and monitoring LTSS and HCBS provider network for compliance.
- Partner with leadership within business area to prioritize opportunities to achieve department and organizational goals.
- Support LTSS updates via network notifications, virtual townhalls, and direct interactions
- Recognize and proactively identify operational dependencies and process improvements
- Develop and maintain dashboard reporting for leadership
- Produce detailed reports and business decision documents
- Develop and maintain an in-depth knowledge of the company’s business and regulatory environments
- Perform any other job-related instructions, as requested
Education and Experience:
- Bachelor of Science/Arts degree or equivalent years of relevant work experience is required
- Minimum of three (2) years of business management or health care operations experience in insurance, managed care, or related industry is required
- Minimum of two (2) years Provider Relations experience is required.
- Advanced knowledge of Medicaid, Medicare, MyCare, LTSS, HCBS, and Ohio Home Care Waiver is required.
- Minimum of two (2) years of experience in leading business initiatives to drive systemic change is preferred
Competencies, Knowledge and Skills:
- Proficient in Microsoft Office Suite to include Word, Excel and PowerPoint
- Proficient in data analysis
- Effective identification of business problems, assessment of proposed solutions to those problems, and understanding of the needs of business partners
- Proven experience with project management tools and resolution of open issues
- Ability to execute small to medium scope project plans including business requirements gathering, definition/prioritization, project scope definition, training, and documentation,
- Comprehensive knowledge of project methodology, scheduling, and forecasting skills
- Excellent written and verbal communication and interaction skills
- Knowledge of regulatory reporting and compliance requirements
- Effective problem-solving skills with attention to detail
- Ability to develop, prioritize and accomplish goals
Licensure and Certification:
- Employment in this position is conditional pending successful clearance of a driver’s license record check. If the driver’s license record results are unacceptable, the offer will be withdrawn or, if you have started employment in this position, your employment in this position will be terminated
- To help protect our employees, members, and the communities we serve from acquiring communicable diseases, Influenza vaccination is a requirement of this position. CareSource requires annual proof of Influenza vaccination for designated positions during Influenza season (October 1 – March 31) as a condition of continued employment. Employees hired during Influenza season will have thirty (30) days from their hire date to complete the required vaccination and have record of immunization verified.
- CareSource adheres to all federal, state, and local regulations. CareSource provides reasonable accommodations to qualified individuals with disabilities or medical conditions, sincerely held religious beliefs, or as required by state law to enable the employee to perform the essential functions of the position. Request for accommodations will be completed through an interactive review process
Working Conditions:
- Mobile Worker: This is a mobile position, meaning that regular travel to different work locations is essential. Will be exposed to weather conditions typical of the location and may be required to stand and/or sit for long periods of time.
- Reside in the state of Ohio.
- May be required to travel greater than 50% of time to perform work duties. A valid driver’s license, car, and insurance are necessary for work related travel
- Required to use general office equipment, such as a telephone, photocopier, fax machine, and personal computer
- Flexible hours, including possible evenings and/or weekends as needed to serve the needs of our member and may refer members to other CareSource resources
- General office environment; may be required to sit or stand for extended periods of time
Compensation Range:
$61,500.00 - $98,400.00
CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type (hourly/salary):
Salary
Organization Level Competencies
This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an inclusive environment that welcomes and supports individuals of all backgrounds.
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