Posted in Other 3 days ago.
JOB SUMMARY: Assist on issues in collaboration with the Subject Matter Expert related to the technical and business aspects of Credentialing and PDM to maintain provider data integrity. During QA testing may provide leadership, direction, instruction, and supervision to the Credentialing and PDM team members.
JOB ROLES AND RESPONSIBILITIES:
1. Act as a liaison between credentialing business area and IT with regard to enhancements, changes and issues which include the following tasks:
* Document business requirements needed;
* Provide appropriate analysis;
* Work closely with IT for Medicaid setup by State within the Credentialing systems;
* Analyze Request for Proposal (RP) for data elements that apply for State and notifying IT if it differs from previous States; and
* Develop in depth knowledge and understanding of how systems feed into each other and how input affects output creating the ability to identify and recognize potential system enhancement issues to troubleshoot with IT.
2. Create the test plans to test enhancements that go into the system. Work with management and IT staff to ensure everything is captured in plans created for testing.
3. Assist in managing User Acceptance Testing enhancements and changes that were worked on with IT and communicate those enhancements and changes to appropriate staff.
4. Report all defects to IT through the standardized IT process.
5. Create, modify and maintain policies and procedures that affect workflow and are produced from changes and enhancements for department.
6. Work to resolve any technical issues or questions related to program and applications. Analyze issues and resolve collaborating with the Subject Matter Expert and IT for resolution if needed.
7. Maintain system processes and stay current on enhancements and processes. Assist in preparing reporting for IT and/or may participate in IT departmental meetings to discuss current status of projects.
8. Develop and create new, and maintain existing, databases to track system enhancements.
9. Assist in performing Quality Assurance testing. Identify quality errors and rates. Collaborate with management & Subject Matter Expert on process improvements designed to improve quality rates.
10. Assist management with selection, development, and evaluation of staff to ensure the efficient operation of department.
11. Collaborate, coordinate, and communicate across disciplines and departments.
12. Ensure compliance with HIPAA regulations and requirements.
13. Demonstrate commitment to the Company's core values.
14. The position responsibilities outlined above are in no way to be construed as all encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned as necessary.
This job works under limited supervision to coordinate all aspects of cross-departmental and interdepartmental projects. The incumbent possesses and applies a range of knowledge gained through experience and knowledge or practices and procedures in the field to complete the job responsibilities. The incumbent balances several projects at a time and work is varied and complex. Work may involve directing team members who do not directly report to this job. Independent judgment may be required to accomplish daily tasks and duties.
JOB REQUIREMENTS (Education, Experience, and Training):
* Minimum Bachelor's degree, or 4 years of related experience in healthcare or insurance
* Required licensures, professional certifications, and/or Board certifications as applicable
* Knowledge of general business and industry principles
* Communication (written, verbal and listening), analytical, problem solving, team building, leadership, presentation and organizational skills
* Ability to demonstrate a high degree of professionalism
* Ability to take initiative and work collaboratively at all levels within the company
* Ability to manage multiple projects simultaneously
* Ability to develop an in-depth understanding of Company's credentialing processes, procedures, and workflows within the Company's Government Business Service Center.
* Ability to keep the needs of external and internal customers a priority when making decisions and taking action.
* Ability to use software, hardware, and peripherals related to job responsibilities, including the Company's Government Business Service Center operation systems, MS Office application including Excel and Access with experience in PowerPoint and Visio preferred
As an Equal Opportunity Employer, the Company will provide equal consideration to all employees and job candidates without regard to sex, age, race, marital status, sexual orientation, religion, national origin, citizenship status, physical or mental disability, political affiliation, service in the Armed Forces of the United States, or any other characteristic protected by federal, state, or local law.