Managed Care Analyst I

DRISCOLL HEALTH PLAN•Corpus Christi, TX

18h

About The Position

The Managed Care Analyst I is responsible for all aspects of the credentialing, re-credentialing, and enrollment process for hospital and hospital-employed providers with contracted health plans. This role involves maintaining up-to-date data in credentialing databases and online systems, ensuring timely renewal of licenses and certifications, and understanding insurance plan requirements for various provider types. The analyst will also assist with establishing and maintaining administrative, legal, operational, and financial opportunities related to contract negotiation and implementation for all areas of managed care through research and analysis. Driscoll Children’s Hospital is a 191-bed tertiary care center serving 31 South Texas counties, offering 32 medical and 13 surgical specialties. Combined with its non-profit, community-based Health Plan, Driscoll Health System is an exceptional workplace that values compassion, advocacy, respect, excellence, and stewardship, exemplified through every position.

Requirements

3-5 years' previous credentialing/enrollment or provider relations experience in related area
Substantial knowledge of payer credentialing
Knowledge of payer processes, local, state, and federal requirements
High level of skills in operating a standard desktop and Windows-based computer system, including but not limited to, Microsoft Word, Excel, PowerPoint, Outlook, database applications, presentation software, Intranet and computer navigation
Excellent organizational, analytical, time management and attention-to-detail skills for the execution of multiple assignments.
Ability to work collaboratively in a team-oriented environment; courteous, professional and friendly demeanor
Ability to work independently with minimal supervision, plan, organize, prioritize assignments and responsibilities and time constraints in a fast-paced environment and adapt to them as they change frequently
Strong oral and written communication skills
Strong organizational skills
Ability to cross-train in other areas of the department in order to achieve smooth flow of all operations
Ability to multi-task and work on multiple projects simultaneously

Nice To Haves

Bachelor's degree in Business Administration or Health Care Administration preferred; other related degrees will be considered based on applicability
Prior experience with EPIC is a plus

Responsibilities

Maintain utmost level of confidentiality at all times.
Adhere to hospital policies and procedures.
Demonstrate business practices and personal actions that are ethical and adhere to corporate compliance and integrity guidelines.
Compiles and maintains current and accurate data for hospital and hospital employed providers.
Maintains copies of current state license, CLIA certificates, education requirements and any other required credentialing documents for hospital and hospital employed providers.
Ability to communicate effectively with all stakeholders across the health system, furthermore, disseminate manage care credentialing updates to key senior leaders across the health system.
Maintains knowledge of current health plan and hospital requirements for credentialing providers.
Sets up and maintains provider information in online (internally and external insurance companies) payer credentialing databases and systems.
Tracks licenses and certification expirations for all providers to ensure timely renewals.
Establishes and maintains provider files to include necessary documentation and understands the plan requirements for credentialing a provider with all of insurance carriers we currently participate with for all types of providers.
Assist departmental leadership in resolving managed care operational issues and provide interpretation of managed care policies, terms, and conditions.
Knowledge of Medicare and Medicaid provider enrollment rules and guidelines.
Complete enrollment applications for various state Medicaid plans
Initiate and support the facility credentialing application process by sending, receiving, analyzing facility documents to determine appropriateness for the facility verification process
Gather, verify, and evaluate confidential and sensitive organizational information, consistent with facility credentialing application requirements
Follows up on the status of applications and provider licenses and facilitates the renewal process; tracks the progress on all pending applications and works to resolve issues as they arise.
Oversees provider online database, tracks licensure expirations and ensures that updated licensures are received.
Manage documentation and proper communication workflows for all new provider credentialing
Supports special project work as needed.
Assumes additional duties as required