Provider Network Operations Analyst

HealthPartners•Bloomington, MN

About The Position

HealthPartners is hiring a Provider Network Operations Analyst. This role promotes and supports provider network related activities within our division and within the organization to ensure HealthPartners provider networks meet sales, regulatory, marketing and administrative system requirements. They manage and coordinate resolution to complex operational issues related to provider network configuration. This position may lead and/or participate in work groups, conduct training, is responsible for addressing operational processes, including issues and questions both internally and externally, and will track and monitor provider network configuration activities.

Requirements

Bachelor’s Degree in a related field (business, compliance, project management, health care)
Five years work experience in a related field (compliance, credentialing, contracting, business or system analysis, project management, managed health care, operations) utilizing MS Office applications
One year work experience involving provider data (e.g. credentialing, provider contracting).
Proven ability to work independently.
Proven organizational skills and the ability to multi-task in a fast paced environment.
Proven team building skills.
Demonstrated excellent analytical and problem solving skills.
Demonstrated ability to take responsibility for performance and attitude on the job.
Demonstrated ability to work collaboratively with others both inside and outside the organization.
Ability to work well with broad and different audiences.
Demonstrated ability to take responsibility for performance and attitude on the job.
Proficient in Microsoft Excel (e.g. data comparison features, filtering, graphing)

Nice To Haves

Experience with HealthPartners Consolidated Provider Network (CPN) application.
Hands-on experience creating training, procedural and policy documentation.
Training experience, preferably in managed care and/or health care operations.
Experience in working in health insurance industry.
Project management experience.
Reporting experience using Business Objects, MS Access or other reporting tools
SharePoint experience

Responsibilities

Understands and support HealthPartners Provider Electronic Commerce and Operations to effectively promote provider network compliance with regulatory areas, both internal and external.
Understands, supports and participates in provider network adequacy monitoring by regulatory agencies such as CMS, DHS, MDH and NCQA.
Participates in cross department work groups involving new network planning, network changes, and implementation including custom networks, new product offerings and specialized networks like COE and high value/preferred providers.
Analyzes provider network terminations and collaborates with other departmental staff on individual providers, clinic and facility terminations to ensure provider network adequacy requirements are met.
Acts as the primary resource for internal departments for provider delivery network questions and new network implementations.
Participates in the creation, review, revision, and maintenance of training materials for internal staff related to changes or revisions to provider delivery networks affecting operations, and involve internal and external parties as needed.
Collaborates with Provider E-Commerce and Operations leaders and staff to prepare for network changes impacting CPN or process flows, and documentation of processes.
Identify, evaluate, and implement CPN database enhancements related to provider network configuration to meet business requirements.
Coordinates provider delivery network configuration set-up and communications on behalf of Provider E-Commerce and Operations including tracking of communications and internal audits.
Analyzes network adequacy requirements to ensure networks meet regulatory requirements for new areas of business.
Identifies areas for ongoing process improvement in areas that impact the department, and cross-departmentally.
Participates in the development and implementation of process improvements, including feasibility of automating processes if applicable.
Supports other business areas in ongoing service needs.
Analyzes and produces reports on a monthly, quarterly or ad hoc basis.
Participate in and create business continuity and disaster recovery plans, tests and revisions.
Performs other duties as assigned.