Function as liaison with the various departments within the organization regarding compliance with contracts and state and federal regulations, including implementation of benefit changes and process/procedure changes.
This position supports the department and provides analysis and reporting for external and internal customers; uses analysis tools such as SAS and Excel to create custom ad hoc analyses to support the needs of internal and external partners.
Accountable for accurately entering prior authorizations into multiple systems, tracking requests, and meeting timeline requirements for decisions and notifications of decisions to members according to corporate policy and government regulations.
This position is responsible for providing dental care and improving oral health for patients; ensures continued viability and success in accessing and treating; providing a positive experience in addressing their oral care needs.
Independently analyze and improve all Windows server hardware and software operating systems to surpass all service level expectations; adhere to all safety and security directives and promote ideas to enhance them.
Develop and maintain information security risk assessments designed to evaluate inherent risks, controls, and residual risks. Effectively advocate within the business for security controls that mitigate.
Develops contracting strategies related to provider risk models and value based care models; directs development of unit cost goals, including individual targets, and manages performance against unit cost budget, including implementation of cost containment initiatives.
Responsible for the day to day operational support of all core and mission critical Windows & Network servers and systems, for company enterprise; implementing Disaster Recovery to support the Corporate Business Resumption Plan.