Ecommerce Provider Data and Compliance Specialist

About the Role

HealthPartners is hiring an Ecommerce Provider Data and Compliance Specialist to promote and support compliance-related activities within our division and organization. This role involves supporting operational issue resolution, participating in trainings and work groups, and tracking regulatory activities.

Responsibilities

• Understand and support HealthPartners Provider Electronic Commerce and Operations options to promote compliance with regulatory areas.
• Monitor regulatory activities as required by agencies such as CMS, DHS, NCQA, and MDH.
• Interact with departmental staff on provider, clinic, and facility terminations to ensure timely member notifications as specified by regulators.
• Participate in creating, reviewing, revising, maintaining, and tracking internal and provider administrative policies and procedures.
• Coordinate provider communications on behalf of Provider E-Commerce and Operations, including tracking required regulatory communications.
• Assist with product and delivery network set-up in CPN, tracking, and documentation upon request.
• Perform audits on CPN transactions using audit reports and completed provider or delivery network alerts.
• Assist in testing enhancements to the CPN application.
• Participate in developing and implementing process improvements.
• Serve as a liaison with internal staff as needed.
• Support business staff in ongoing service needs.
• Participate in and assist with business continuity and disaster recovery plans, tests, and revisions.
• Perform other duties as assigned.

Qualifications

• Four-year degree in a related field (customer service, training, project management, business, or health care) or two years of related work experience in lieu of a degree.
• Two years of work experience in a related field (compliance, claims, electronic commerce, contracting, business or system analysis, customer service, training, project management, health care operations).
• Intermediate Microsoft Excel skills.
• Proven organizational skills.
• Ability to work independently.
• Ability to multi-task in a fast-paced environment.
• Strong interpersonal skills.
• Demonstrated analytical and problem-solving skills.
• Demonstrated ability to take responsibility for performance and attitude on the job.
• Demonstrated ability to work collaboratively with others both inside and outside the organization.
• Ability to work well with broad and different audiences.

Preferred Qualifications

• Training experience, preferably in managed care and/or health care operations.
• Experience working in a managed care organization or provider office.
• Project coordination skills.