This role is the organizational expert on issues related to the technical and business aspects of Provider Data Management (including Credentialing, Contract Management and PDM areas) to maintain provider data integrity acting as a mentor to dependent team members. During User Acceptanace Testing (UAT) and/or Businesses Acceptance Testing (BAT) testing the incumbent will provide coaching, leadership, direction, instruction, and supervision to team members.
JOB ROLES AND RESPONSIBILITIES:
1. Utilize subject matter expertise to support a team of paralegals and contract admins responsible for accurate and timely processing of various group contracts.
2. Conduct regular audits of contracts processed by paralegals and contract admins
3. Act as the primary team liaison between the business and information technology (IT) with regard to enhancements, changes and issues (including business requirements oversight, network setups, and state regulation review)
4. Create and manage business test plans for testing system enhancements. Partner with management and information technology (IT) staff to ensure everything is captured in business test plans.
5. Manage Business/User Acceptance Testing enhancements/changes and communicate those enhancements and changes to appropriate team members.
6. Report all defects to IT through the standardized IT processes.
7. Create, modify and maintain policies and procedures that affect workflow and are produced from changes/enhancements for department.
8. Appropriately resolve any technical issues or questions related to program and applications. Develop action plans to appropriately resolove relevant issues through collaboration with IT and management as needed..
9. Present enhancements, progress and current issues to IT and/or participate in IT departmental status meetings.
10. Develop, create, and maintain databases to track system enhancements.
11. Lead client facing audits specific to departmental processes. Manage reporting, review processes, and lead client web meetings to review associated processes and data associated. May be a point of contact for matrix partners cross-organizationally.
12. Create trend reporting based on feedback from client audit results to drive enhancements to processes.
13. Manage the quarterly and semi-annual reporting of client facing Provider Data Management related information.
14. Perform Quality Assurance testing. Identify quality errors and rates. Collaborate with management on process improvements designed to improve quality rates. Coach staff members as needed and identified by management on trending Quality Assurance tested items.
15. Assist management with selection, development, and evaluation of staff to ensure the efficient operation of department.
16. Collaborate, coordinate, and communicate across disciplines and departments.
17. Ensure compliance with HIPAA regulations and requirements.
18. Demonstrate Company's Core Competencies and values held within.
19. Please note due to the exposure of PHI sensitive data -- this role is considered to be a High Risk Role.
20. 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 independently to coordinate all aspects of cross-departmental and interdepartmental projects. The incumbent possesses and applies a wide range of knowledge gained through experience and knowledge of 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 involves acting as a mentor including directing and coaching team members who do not directly report to this job. The role requires the incumbent serve as a key point of contact for matrix partners on various related processes. Independent judgment is required to accomplish daily tasks and duties.
JOB REQUIREMENTS (Education, Experience, and Training):
* Minimum high school diploma and five (5) years' of related experience withn the healthcare industry. Bachelors' degree is strongly preferred.
* Some legal background
* Familiarity with contract management software & processes
* Minimum 1 year experience in direct and/or indirect leadership
* Knowledge of general business and industry principles
* Communication (written, verbal and listening), analytical, problem solving, team building, leadership, presentation and organizational skills
* Ability to serve as SME on technical issues
* Ability to mentor, coach and lead
* 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 Operational processes, procedures, and workflows.
* 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, MS Office application including Excel and Access with experience in PowerPoint and Visio preferred
Required licensures, professional certifications, and/or Board certifications as applicable
**Pursuant to Colorado’s “Equal Pay for Equal Work Act”, the following salary range is provided solely for applicants living in Colorado: $61,000 to $90,000. If an applicant does not live in Colorado, this salary range may not apply. Specific offers take into account a candidate’s education, experience and skills, as well as the candidate’s work location and internal equity. This position is also eligible for health insurance, 401k and bonus opportunity.
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.
- Acceptance Testing
- Process Improvements (Business)
- Business Requirements
- Microsoft Access
- Test Planning