Job Summary:
The Provider Network Operations Analyst II executes small project plans and provides support for new market implementations along with existing markets and products
Essential Functions:
- Partner with Network and Operations leadership within business area to determine and prioritize opportunities to achieve the goals for a successful implantation implementation
- Act as a business liaison between the markets and various operational departments on key initiatives within the Network Development space, including coordination for internal and external activities
- Assist in the loading of providers into the databases, including auditing the loads afterwards
- Identify, analyze, and present solutions to mitigate barriers through the implementation process
- Manage multiple projects, collect, and analyze data and disseminate to appropriate departments as necessary
- Facilitate the identification of steps needed for operational readiness through on-going monitoring and providing regular reporting and maintain ongoing communications to management
- Develop and maintain an in-depth knowledge of the Network Development landscape and regulatory environments
- Assist in development of action plans throughout the business and establishes control plans for implemented projects
- Work collaboratively with various business units in identification, definition and communication of process metrics
- Perform any other job-related instructions, as requested
Education and Experience:
- Bachelor of Science/Arts degree or equivalent years of relevant work experience is required
- A minimum of three (3) years of business management or health care operations experience in insurance, managed care, or related industry is required
- A minimum of two (2) years of experience in leading business initiatives to drive systemic change is preferred
Competencies, Knowledge and Skills:
- Proficient in Microsoft Office Suite to include Word, Excel and PowerPoint
- Proficient in Facets, OnBase, and Cactus navigation and workflow
- Knowledge of Provider data standards, structure, and set up
- Knowledge of relational data structure and management
- Knowledge of SQL, including the ability to create/modify custom queries using joins and data formatting is preferred
- Knowledge of regulatory reporting and compliance requirements
- Effective identification of business problems, assessment of proposed solutions to those problems, and understanding of the needs of business partners
- Proven experience with project management tools and resolution of open issues
- Ability to execute small to medium project plans including business requirements gathering, definition/prioritization, project scope definition, , application configuration, testing approach, training, documentation, and reporting
- Excellent written and verbal communication and interaction skills
- Effective problem-solving skills with attention to detail
- Ability to develop, prioritize and accomplish goals
Licensure and Certification:
- None
Working Conditions:
- General office environment; may be required to sit or stand for extended periods of time
Compensation Range:
$61,500.00 - $98,400.00
CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type (hourly/salary):
Salary
Organization Level Competencies
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Create an Inclusive Environment
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Cultivate Partnerships
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Develop Self and Others
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Drive Execution
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Influence Others
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Pursue Personal Excellence
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Understand the Business
This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an inclusive environment that welcomes and supports individuals of all backgrounds.
Top Skills
What We Do
Health Care with Heart. It is more than a tagline; it’s how we do business. CareSource has been providing life-changing health care to people and communities for nearly 30 years and we will continue to be a transformative force in the industry by placing people over profits.
CareSource is and will always be members first. Even as we grow, we remember the reason we are here – to make a difference in our members’ lives by improving their health and well-being. Today, CareSource offers a lifetime of health coverage to nearly 2 million members through plan offerings including Marketplace, Medicare Advantage and Medicaid. With our team of 4,000 employees located across the country, we continue to clear a path to better life for our members. Visit the "Life" section to see how we are living our mission in the states we serve.
CareSource is an equal opportunity employer and gives consideration for employment to qualified applicants without regard to race, color, religion, sex, age, national origin, disability, sexual orientation, gender identity, genetic information, protected veteran status or any other characteristic protected by applicable federal, state or local law. If you’d like more information about your EEO rights as an applicant under the law, please click here: https://www.eeoc.gov/employers/upload/poster_screen_reader_optimized.pdf and here: https://www.dol.gov/ofccp/regs/compliance/posters/pdf/OFCCP_EEO_Supplement_Final_JRF_QA_508c.pdf
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