Performance & Network Compliance Analyst

Community Health Plan of Washington•Seattle, WA

7h•$73,010 - $111,710•Onsite

About The Position

This position is responsible for coordination and execution of provider network regulatory deliverables and compliance activities, including oversight of reporting processes, submission timelines and regulatory requirements. The role partners with internal stakeholders to ensure accurate, timely and compliant submissions, including Behavioral Health network reporting, performance improvement and regulatory readiness.

Requirements

Have an associate degree or an equivalent combination of education and highly relevant experience required.
Have a minimum of three (3) years’ experience working with health care professionals.
Have a minimum of three (3) years’ experience in managed care, required.
Have a minimum of two (2) years of experience managing large amounts of complex data and reconciling data output.
Have knowledge of Centers for Medicare & Medicaid Services (CMS), Healthcare Authority (HCA), Office of the Insurance Commissioner (OIC) Washington State managed care network regulatory requirements.
Demonstrated excellent oral, written, interpersonal and analytical skills.
Skills in data management accuracy, QA processes and ability to work with multiple and complex data sets.
Ability to collect, organize, analyze, and disseminate significant amounts of information with diligence and accuracy.
Ability to independently identify and analyze trends and initiate pro-active interventions.
Advance proficiency with Windows software including Microsoft Word, Excel, and Access.
Effective organizational and time management skills.
In-depth knowledge of products and managed care operations.
Complete and successfully pass a criminal background check.
Has not been sanctioned or excluded from participation in federal or state healthcare programs by a federal or state law enforcement, regulatory, or licensing agency.
Vaccination requirement (CHPW offers a process for medical or religious exemptions)

Nice To Haves

Have experience in project coordination and office support, preferred.
Experience with SQL, Pivot Tables and PowerPoint preferred.

Responsibilities

Performs daily troubleshooting to ensure and provide timely responses to agency inquiries and requests, coordinating with relevant departments and stakeholders for resolution of objections from regulatory entity.
Develops project status reports and business requirements for internal stakeholders on a regular basis.
Develops and maintains model to assess and monitor Community Health Plan network development strategies, ensuring alignment with organizational goals.
Collaborates with subject matter experts to track key performance indicators, identify trends and recommend interventions for network improvement.
Analyzes demographic and utilization data to support regulatory filings and identify opportunities for network expansion.
Sub-division coordination and planning of TEAMonitor narratives, supporting documentation, timelines, communications and QA processes.
Monitor Behavioral Health network and outreach in support of Quarterly HCA Provider Network Submission, to include regular review of geographic/service coverage of Behavioral Health Agencies.
Maintains Behavioral Health AADR process and project plan development quarterly in alignment with contract department review.
Develops of Mental Health Assessment utilizing claims information and compilation of data sets to support analysis.
Coordinates resolution of contracting provider data gaps impacting regulatory submissions, ensuring reliability, completeness, consistency and compliance.
Develops and maintains processes to track and manage regulatory deliverables, resolving issues to ensure accuracy of narratives and data submissions, to include TEAMonitor coordination and HCA contract reviews.
Collaborates across departments and teams to initiate and deliver projects that advance network strategy and fosters interdepartmental partnerships.
Supports the development of internal consulting capabilities for CHPW to strengthen delivery systems performance.
Participate in cross-training with department analysts and program managers.
Other duties as assigned.