Duties:

• Provide ongoing business and technical direction relative to provider data structures that are national or regional in scope in support of claim adjudication and directory production.

• Establish/maintain and align contracted provider demographic data and negotiated reimbursement arrangements across provider systems.

• Review new and existing contract reimbursement arrangements for compliance with standards and determine most appropriate system input methodology that facilitates accurate and consistent claim adjudication.

• Collaborate with Core Regional Network Operations on exception process, automation enhancements and continuous quality improvements.

• Partner with internal/external resources in cross-organizational/functional development projects (i.e., workflow process analysis, system enhancements, medical expense reduction initiatives and legislative requirements).

• Maintain cooperative working relationships with internal Client contacts.

• Analyze, identify and report on significant changes to network configuration and market information.

• Provide operational assistance to Operations and Network Management in support of network development, re- contracting and credentialing projects.

• Extract information from provider systems to meet business reporting needs.

• Partner with Core Regional Network Operations to manage contract administration process by providing implementation and ongoing maintenance support and direction on technical and business processes.

• Work with Contracts Administration to ensure appropriate contract implementation requirements are met (e.g. Provider Groups are setup as required by a Group contract vs. a Vendor contract).

• Assist Network Management by participating in presentations to existing and prospective customers.

• Work with management to draft, clarify and recommend changes to policies which impact network management.



Experience:

• Track record of prioritizing work multi-tasking and managing workload efficiently.

• Possesses a working knowledge of Intuit QuickBase, MS Excel, Outlook, Word a plus.

• Knowledge of managed care business and healthcare environment mandatory.



Position Summary:

• Provides operational support and performs data maintenance for data transactions (Basic to complex).

• In addition, perform data transactions and maintenance associated with projects, expansions, and new product implementations.



Education:

• College degree or equivalent work experience preferred.



Required Skill Set:

Claims, Implementation, Management, Microsoft Excel, Microsoft Outlook, Multitask



Position Type: Temporary