Provider Data Quality Admin (Hybrid - Troy, MI) - Health Alliance Plan

GENERAL SUMMARY:

The Provider Data Quality Admin is responsible for process oversight, planning, implementation, and coordination of the applications within the Provider Network Management department, as it relates to the integrity of provider reporting and provider data. The Provider Data Quality Admin must represent the Provider Network Management Department and seamlessly vacillate between projects with enterprise stakeholders on a variety of topics related to provider data, provider reporting and compliance.

PRINCIPLE DUTIES AND RESPONSIBILITIES:

• Participate in or facilitate projects to represent Provider Network Management.
• Establish a comprehensive understanding of the lease networks and the impacts those contracts have on network compliance and reporting requirements.
• Develop and maintain methods to ensure service level agreements and key performance indicators are met and reported.
• Oversight of Provider Network Management customer relations management workflow compliance. This includes dashboard reporting, root cause analysis of process gaps and collaboration with other HAP business units to resolve.
• Gather, compile, analyze and interpret internal information to support all business functions using MS Access, Visio, MS Excel, Cognos, Geo Mapping and Network Adequacy software, HAP databases and other sources, while designing and generating ad hoc and standardized reports.
• Lead and coordinate Provider Network Management initiatives guiding multiple resources to design, execute, analyze, and interpret reports which draw upon multiple data sources, identify growth opportunities, competitor offerings and product performance.
• Oversight and monitoring compliance of the provider directory both static and dynamic.
• Act as a key liaison with lease networks and vendors to ensure seamless interactions and escalation.
• Act as a key liaison to either facilitate or develop department policies and procedures.
• Remain current with CMS, QHP, MDHHS, NCQA, OIG and other compliance requirements as it relates to Provider Network Management, ensuring all
  departmental policies remain compliant.
• Lead and coordinate compliance related reporting, including development of, and uploading documents to regulatory agencies including CMS, DIFS and MDHHS.
• Communicate insights, conclusions, and recommendations drawn from analysis in both written report and verbal presentation form, to direct business decision making.
• Facilitate responses to compliance related to process and reporting gaps, including development and oversight Corrective Action Plans.
• Identify potential product adjustments, additions and deletions based on provider network data and support the product management lifecycle through analyzing product membership and performance.
• Gather documentation from subject matter experts to produce NCQA qualitative and quantitative analysis for standards assigned to Provider Network Management.
• Act as a consultant on provider network adequacy, provider network disruption and geo access reports.

This posting represents the major duties, responsibilities, and authorities of this job, and is not intended to be a complete list of all tasks and duties. It should be understood, therefore, that employees may be asked to perform job-related duties beyond those explicitly described above.