Address
Form of workUnder the general direction of the Assigned Management, this position supports the team’s activities related to, but not limited to, the collection and reporting of provider data used for Provider Directory publishing purposes, Health Provider Network (HPN), Managed Care Provider Data System (PNDS) and PDF submissions. The incumbent acts as internal and external subject matter expert for the Provider Data Management Team.
Essential Responsibilities/Accountabilities:
• Implements and conducts training programs and evaluates their effectiveness on an ongoing basis.Identifies improvements in the programs. Assists in operations needs analyses to determine skill gaps and employee developmental/education and training needs. Recommends curriculum and courses based on results.
• Trains individually or in groups on job content, operating procedures, accountabilities of assigned positions and general instructional procedures. Conducts training to coincide with system conversions, new legislation and regulatory rulings.
• Evaluates trainees' progression and capabilities during all phases of training and makes appropriate recommendations. Conducts progress reviews on and provides constructive feedback to trainees in a timely manner.
• Accountable for classroom management and advises trainee(s)' supervisor of any issues that occur which are outside their scope of authority, as well as any training competency issues.
• Acts as a resource subject matter expert for provider data management requirements. Coordinates the work of staff as assigned by management and provides mentor support to the team. Assures data reporting meets state, federal and all other governing bodies’ regulations.
• Interfaces with IT division to define provider system(s) requirements for improving existing processes and/or new processes. Supports implementations of system changes/upgrades with IT division.
• Handles escalated provider File Management assignments requiring research, coordination of workgroups to resolve issues, outreach to providers, and/or communication to management on issue and resolution approach.
• Analyzes trends in the provider file to identify data discrepancies, researches discrepancies, and independently addresses root cause. Performs updates to provider file stemming from inventory demands or projects as required. Prepares reports and detailed business documents as required.
• Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values, adhering to the Corporate Code of Conduct and leading to the Lifetime Way values and beliefs.
• Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.
• Regular and reliable attendance is expected and required.
• Performs other functions as assigned by management.
Minimum Qualifications:
• In lieu of degree, a minimum of 9 years of experience in Provider File Management or Facets experience required. Bachelor’s degree in Business Administration, Health Care Administration or related field with a minimum of three years’ experience in Provider File Management or Facets.
• Strong interpersonal skills; must work well within a team including lead responsibilities. Demonstrated skills in conflict resolution.
• Experience with Project Management skills and ability to troubleshoot and problem solve. Ability to apply quality principles and tools.
• Proficient in Microsoft Office including, Excel, Word, PowerPoint and Access.
• Excellent communication skills and the ability to work in a team environment.
• Effective business problem solving skills.
• Very strong analytical and business process development skills.
Physical Requirements:
• Ability to work prolonged periods sitting at a workstation and working on a computer.
• Ability to work while sitting and/or standing while at a workstation viewing a computer and using a keyboard, mouse and/or phone for three (3) or more hours at a time.
• Ability to work in a home office for continuous periods of time for business continuity.
• Ability to travel across the Health Plan service region for meetings and/or trainings as needed.
• The ability to hear, understand and speak clearly while using a phone, with or without a headset.
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One Mission. One Vision. One I.D.E.A. One you.
Together we can create a better I.D.E.A. for our communities.
At the Lifetime Healthcare Companies, we’re on a mission to make our communities healthier, and we can’t do it without you. We know diversity helps fuel our mission and that’s why we approach our work from an I.D.E.A. mindset (Inclusion, Diversity, Equity, and Access). By activating our employees’ experiences, skills, and perspectives, we take action toward greater health equity.
We aspire to reflect the communities we live in and serve, and strongly encourage people of color, LGBTQ+ people, people with disabilities, veterans, and other underrepresented groups to apply.
OUR COMPANY CULTURE:
Employees are united by our Lifetime Way Values & Behaviors that include compassion, pride, excellence, innovation, and having fun! We aim to be an employer of choice by valuing workforce diversity, innovative thinking, employee development, and by offering competitive compensation and benefits.
In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position.
Equal Opportunity Employer
