Description: Please see below.
- Supervises staff performing contractfinancial analytics as well as staff coordinating provider demographic data management across the enterprise. Initially represents staff of 4.
- Manages contract and vendor relations for network adequacy software. This includes coordination with KPIT on loading software and updating software, establishing and manager a defect management program, a release management process, and an enhancement management review process. In addition, position is responsible for contract oversight and coordination of revisions to the contract based on new or changing requirements.
- Collaborates with and consults to Regions, Regulatory staff, legal and Government Relations staff related to regulatory and accreditation requirements for network adequacy and provider directory production.
- Responsible for coordination of provider data directory submissions to the Private Exchanges. This includes working with Regions and vendors establish criteria for what will be distributed, providing oversight to the data collection and submission process, insuring that adequate and appropriate testing has occurred and creating a replicable process to accommodate monthly submissions.
- Position will develop recommendations for a process to collect, manage and disseminate provider demographic data across the enterprise in collaboration with key leadership and stakeholders.
- Responsible for implementation of software solutions at the national and regional level for purposes of collecting and managing demographic data, assessing network adequacy across multiple lines of business, collecting data necessary for directory production. This work includes develop of data strategies and solutions in conjunction with the Chief Data Office and the National Provider Data Management function.
- Directs the activities related to data gathering and analysis of National Provider Contract. Interacts with end users to determine needs. Trains end users in use of produced reports. Manages the activities of data analysis staff.
- Provides analytic training to staff.
- Develops long-range plan for data gathering and organization.
- Works with Senior Contract Manager and Contracting Director to help develop contracting strategies.
- Maintains communication, working relationships, and identifies synergies with National Actuarial, Claims, Finance, and Product Management departments.
- Develops analytical strategy related to contracting for new projects with high visibility, such as regional acquisition of hospitals and other KP expansion initiatives.
- Discovers, investigates, and plans strategic implementation of analytical tools that are new to market or necessary for specific initiatives.
- Develops strategy for reporting of performance on national held contracts to regional leaders and stakeholders.
- Assigns tasks and projects related to provider data management and provider contracting to staff.
- Develops and implements methodology for timely tracking of progress on staff's assigned projects.
- Minimum five (5) years of experience in analytical work related to provider contract negotiations, provider contract performance, or medical claims.
- Bachelor's degree OR four (4) years of experience in a directly related field.
- High School Diploma or General Education Development (GED) required.
License, Certification, Registration
- Proficiency in at least one query tool such as MS Access, MS SQL, SAS, Toad, etc. Advanced level ability with MS Excel.
- Proficiency in MS Access, MS SQL, and SAS is preferred.
- Eight (8) years of experience in analytical work related to provider contract negotiations, provider contract performance, or medical claims. Five (5) years work experience related to provider contracting analysis.
- Master's Degree.