Provider Operations Analyst II (Health Plan/Provider Data Experiencr)

Job Summary The Provider Operations Analyst II is responsible for assimilating large quantities and/or complicated data into meaningful formats for tracking and status requirements. Essential Functions Develop queries to identify and quantify provider data issues within the organization and assist in the development plans to resolve data issuesProvide operations teams; Contracting, Credentialing, Data Load, Directories, and Pended Claims with analysis and oversight for all provider data, workflows and processesAct as Subject Matter Expert (SME)/Business Analyst/Data Analyst for Provider Operations team on various initiatives/special projectsWork cross functionally with Claims, Configuration, Market Reps, and Provider Operations to integrate business processes and workflowsIdentify, develop, and implement reporting and/or business processes to ensure adherence to data quality, operational excellence, regulatory and compliance requirementsDevelop and monitor daily metrics for staff quality, productivity, making recommendations for change as neededManage and conduct root cause analysis for high-level escalations that involve intensive research and resolutionManage special projects through to resolution that may involve high dollar unpaid claims, risk of state complaint, risk of provider refusing to serve CareSource member(s), or risk of not meeting compliance requirementsDevelop, document and perform testing and validation as needed for process and system changesServe as a primary point of contact for vendors and business partners that are sending and receiving CareSource provider dataSubmit appropriate requests through the operations workflow to make updates on provider dataIn collaboration with Talent Development, develop and present training modules and responsible to present to staff as neededPerform any other job duties as requested Education And Experience Bachelor’s Degree or equivalent years of relevant work experience is requiredA minimum of three (3) years of health care or managed care experience is requiredExperience working on a Claims systems, preferably Facets, preferredExperience in provider relations, contracting, onboarding, credentialing, directories, pended claims, or configuration is highly preferred Competencies, Knowledge And Skills Overall knowledge and understanding of one or more key provider systems, including Choreo/Contract Manager, Cactus and Facets.Ability to manage multiple initiatives exhibiting excellent organizational and collaboration skillsAbility to effectively interact with all levels of management within the organization and across multiple organizational layersDemonstrates excellent analysis and supporting technical skills to include SQL/Access capabilitiesTime management skills, ability to develop, prioritize and accomplish goals with a sense of urgencyAbility to multi-task and remain flexible during organizational and/or business changesExceptional communication (verbal and written), facilitation and presentation skillsStrong interpersonal, leadership and relationship building skillsCritical listening, thinking, and problem resolution skillsCustomer service orientedAbility to understand workflows, process improvement, and work with Leaders to implement required changesProficient in data analysisAdvanced MS Excel, PowerPoint, and Word skills Licensure And Certification None Working Conditions General office environment; may be required to sit or stand for extended periods of timeMay be required to travel, estimated at less than 10% $62,700.00 - $100,400.00 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. Salary Organization Level Competencies - Fostering a Collaborative Workplace Culture - Cultivate Partnerships - Develop Self and Others - Drive Execution - Influence Others - Pursue Personal Excellence - Understand the Business 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 environment of belonging that welcomes and supports individuals of all backgrounds.