||The role of this position is as a relationship manager and operations role for an internal Managed Care Contracting Department servicing all members in Northern Light Health. This position serves in the role of supporting policy, practices, and collaboration with operational departments for improved operations of both new and existing managed care payer contracts for all Northern Light Health organizations. The primary responsibility of this role is to serve as an internal Analyst with financial, health care acuity and the ability to provide analysis and support to management to promote strong operational components to current contracts as well as Northern Light Health departments. Strong communication and project management skills are required. This role will analyze data relevant to Managed Care Contracting Department compliance and in support of the pilot project initiatives. In addition this role will serve in the areas of organizational development, change management, performance monitoring, and other needs as identified. The Analyst will support system-wide payer relationship management and negotiations with an eye on operationalizing contracts, providing training opportunities, claims issues resolution, and provider relations to both our Northern Light Health membership and our contracted payers. These tactics may involve the need to: gather criteria or data sets, analyze findings, design solutions, write specifications and implement new and improved processes and recommend ongoing controls and protocols as well as other broader and unique tasks. Effectiveness of this position shall be measured by departmental LEMs, assisting operational teams on payer changes and relationship management, customer service satisfaction, and data management of relevant tasks and measurements.It is critical that this position be highly effective in delivering the services described below and work harmoniously with staff in the various departments across Northern Light Health. Effectiveness will be measured in terms of results, commitment to Northern Light Health and customer satisfaction (at all levels).
General · Review and analyze operational effectiveness of Managed Care contracts.· Assists with relationship management / issue resolution between payer and providers. · Assists in providing gap analysis between actual and targeted outcomes.· Monitors outcomes of business intelligence, decision support and communication applications· Ability to manage multiple priorities simultaneously· Provides operational analysis and summarize data challenges of the customer.· Communicates status updates, feedback, areas of improvements based on review strengths and weaknesses relating to contracting leaders.· Provides support for inquiries or issues related to credentialing, reimbursement, claims processing, and other operational departments related to contract. · Contributes to templates and communication development.· Identify and assists in remedying communication issues· Collaborates on educational events to ensure access and knowledge of payer tools.· Perform other duties as assigned.Technology · Work collaboratively with operational staff to identify data sources for evaluating new contracts and tracking performance of existing contracts.· Update and maintain share point site.· Tracks contract signature process, updates Mediregs as needed· Other systems as assignedTraining & Education· Work closely with operational directors and managers to identify areas requiring intervention with Managed Care payers.Professional Development· Attend local, and regional conferences/seminars to become fluent in Managed Care Contracting and the departments it services.· Remain current in data manipulation and analysis knowledge by attending various seminars and classes relevant to current business needs.· Reviews Third Party Regulatory publications to maintain knowledge base concerning compliance, billing requirements, reimbursement and coverage issues. Distribution of such notices will be forwarded to operational departments as is appropriate.· Maintains current knowledge of regulatory developments
|Duties and Responsibilities|
· Bachelor's degree required. Four (4) years of progressively responsibly experience in healthcare or business accepted in lieu of degree OR Associates degree and two (2) years of experience in healthcare or business accepted.· Working knowledge of payer contracts, reimbursements, and data streams.· Demonstrated experience in gathering, diagnosing, evaluating and developing corrective actions. · Working knowledge of functional areas of the healthcare and contracting departments impact on such· Excellent communications skills, both oral and written. · Intermediate Microsoft software knowledge and ability to train/assist end-users. · Ability to interpret an extensive variety of instructions furnished in written, oral, diagram, or schematic form. · Ability to influence change. · Flexible and able to react to ever changing priorities.· Experience with Northern Light Health Software, data and business information is preferred.Physical RequirementsLight to Medium carrying / lifting up to 30 lbs. with some bending, straight pulling/pushing, reaching in all directions, stooping, walking long distances, standing, sitting, Manual dexterity and ability to use both hands in a repetitive manner. Requires a stationary position for 80% of the work day. Dexterity with use of computer keyboard and writing implements. Must be able to work in an open office environment and possesses visual and hearing acuity necessary to discern information from the telephone, computer, printed forms, written and oral instructions from coworkers and others. Travel Requirements
|Qualifications / Experience|
Equal Opportunity Employment
We are an equal opportunity, affirmative action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, age, disability status, gender, sexual orientation, ancestry, protected veteran status, national origin, genetic information or any other legally protected status.
|· 20-40 % Travel may be required.· Employee must have a valid driver's license and possess own transportation.|