Provider Network Specialist jobs in Burnsville, MN

This position is responsible for creating provider network reports for various regulators and quality monitoring organizations (DHS, CMS, MDH and NCQA). Responsible for the data populating UCare provider directories and online provider search. Collaborate with internal team members to ensure high quality and accurate provider data.

· Analyze and review provider demographic data for accuracy. Collaborate with provider data team to assess and monitor ongoing provider demographic data veracity. Leverage provider data massaging techniques to trend and identify patterns in the provider data and identify opportunities for improvement.

• Administer provider directory and provider search production. Develop and maintain procedures and policies related to accurate production of provider directories and UCare.org’s provider search. Ensure compliance with State and Federal regulations. Prepare and analyze provider network control total reporting to ensure consistent and expected provider data display in provider search and directories.

• Coordinate organizational operations relating to provider network changes. Work with departments from across the organization to ensure timely and comprehensive responses to provider facility terms and closures. Own and maintain policies and procedures surrounding the term process.

• Produce monthly provider network files for DHS. Initiate provider data extracts from multiple sources, audit data and coordinate with Government Relations and Information Technology for successful delivery of data.

• Conduct audits of credentialing platform data, claims platform data, delegated source data and contracting data store for provider network data accuracy. Research practitioner and provider data information through public datasets, websites and phone verification.

• Analyze, maintain and monitor rules engine used to assign members to care coordination delegates. Ensure excellent member services by representing provider data domain on cross departmental work group dedicated to member care coordination.

• Coordinate and respond to inquiries both internally and externally surrounding provider data as configured in source systems and displayed in provider search and provider directories.

• Other projects and duties as assigned

Education

Bachelor’s degree or equivalent in health care management or related field preferred; demonstrated work experience may be considered in lieu of degree.

Required Experience

One year of experience in a health delivery setting, such as physician group practice, health insurance, HMO or community service agency or one to three years of experience related to Health Plan operations. Demonstrated programming skills and experience may be considered in lieu of health care experience.

Preferred Experience

Experience with Analytical problem solving, long-term projects and data validation. Experience with Quest Analytics. Cactus, HealthRules, Amisys or credentialing and claims platform experience.

THE UCARE DIFFERENCE

The UCare difference is our people power – employees actively working on the behalf of our members to get them access to the health care they need. We value and respect each individual's ideas and contributions, and provide the freedom to grow both personally and professionally. We are centrally located, and offer onsite education, equipment and wellness resources, and a myriad of volunteer activities. If you're looking for an inclusive environment that celebrates your people power, helps you build on your strengths and gives you the opportunity to truly make a difference, we invite you to apply.

As an Equal Opportunity/Affirmative Action Employer, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve.

JOB POST DATE: 4/7/2023