Provider Data Management Supervisor
Apply on line at http://www.alohacare.org/Careers/Default.aspx
The Company:
AlohaCare is a local, non-profit health plan serving the Medicaid and Medicare dual eligible population. We provide comprehensive managed care to qualifying health plan members through well-established partnerships with quality health care providers and community-governed health centers. Our mission is to serve individuals and communities in the true spirit of aloha by ensuring and advocating access to quality health care for all. This is accomplished with emphasis on prevention and primary care through community health centers that founded us and continue to guide us as well as with others that share our commitment. As Hawaii’s third-largest health plan, AlohaCare offers comprehensive prevention, primary and specialty care coverage in order to successfully build a healthy Hawaii.
The Culture:
AlohaCare employees share a passion for helping Hawaii’s most underserved communities. This passion for helping and caring for others is internalized and applied to our employees through a supportive and positive work environment, healthy work/life balance, continuous communication and a generous benefits package.
AlohaCare’s leadership empowers and engages its employees through frequent diversity, recognition, community, and educational events and programs. AlohaCare has a strong commitment to support Hawaii’s families and reinforces a healthy work/home balance for its employees. Because AlohaCare values honesty, respect and trust with both our internal and external customers, we encourage open-door, two-way communication through daily interactions, employee events and quarterly all-staff meetings. AlohaCare’s comprehensive benefits package includes low cost medical, dental, drug and vision insurance, PTO program, 401k employer contribution, referral bonus and pretax transportation and parking program.
These employee-focused efforts contribute to a friendly, team-oriented culture which is positively reflected into the communities we serve.
The Opportunity:
The Provider Data Management Supervisor is accountable for the end to end accuracy of AlohaCare’s provider data and maintenance of supporting documentation for its credentialed and contracted provider network. The Supervisor oversees a team of staff who accomplish intake, data entry, records maintenance, system configuration, reporting and problem solving. This team operates with aloha in their daily interactions with provider office personnel and its responsiveness is critical to maintaining positive relationships for the organization. Close oversight of the validity and accuracy of provider data is central to assuring that our members have access to needed care. The Provider Data Management Supervisor reports to the Sr. Manager of Credentialing and Provider Data Management.
Primary Job Duties and Responsibilities:
· Oversees, plans, assigns and evaluates the work of department staff, including:
o Initiate new records in credentialing system & input demographic updates
o Enter contracted provider data into core system & configure contracts
o Maintain rosters and provider affiliations for contracted groups, IPAs, ACOs & other umbrella entities
o Setup provider accounts for provider portal, EFT & other internal systems
o Verification of non-credentialed provider types
o Administration of the PCP enhancement program
o Create/update provider data & contract designations in core system
o Research/adjust contract setup to address claims processing issues
o Provide contract information & setup status updates to other departments
o Conduct ongoing provider data validation and quality assurance audits
o Develop, execute & validate provider data reports to support regulatory requirements accreditation standards and provider network adequacy analysis
o Develop and execute provider data processing reports for measurement to performance metrics
o Maintain configuration of credentialing system & relationship with system vendor
o Provides technical expertise to staff as well as establishes workflows, quality validation and communication structures.
o Develops and maintains Policies and Procedures for Provider Data Management work.
o Assists with recruitment and selection of new staff.
o Provides training, mentoring, periodic assessments of staff competencies, perform annual reviews, enforces disciplinary activities related to job performance and discharge duties when applicable.
o Develops and/or monitors work plans and determines priorities.
o Responsible for end to end accuracy and completeness of provider data and supporting documentation
o Resolves issues encountered during daily operations and determines standards for problem resolution.
o Serves as subject matter expert on provider data, related processes and systems used to meet regulatory, contractual and accreditation requirements.
o Responsible to maintain AlohaCare’s confidential information in accordance with AlohaCare policies, and state and federal laws, rules and regulations regarding confidentiality. Employees have access to AlohaCare data based on the data classification assigned to this job title.
o Availability to work extended hours on a case-by-case basis to address business needs.
o Other duties as assigned.
Required Competencies & Qualifications:
· Associates Degree
· Two to three years’ experience in managed or health plan provider contract management systems.
· Minimum of two (2) years of supervisory experience
· Advanced skills using Microsoft programs; Word, Excel and Outlook
· Advance skills with Adobe programs
· Cultural diversity, sensitivity and excellent people skills
· Exceptionally organized, process thinker able to oversee efficiency and accuracy of work performed by assigned team members
· Strong listening skills
· Positive attitude and energy
· Ability to provide clear, concise and effective training
· Excellent verbal and written communication skills, including interpersonal interaction
· Flexibility and adaptability to changing priorities
· Demonstrated ability to review and quality check the accuracy of data entry and reports
· Ability to think and prioritize work tasks independently
Preferred Competencies & Qualifications:
· Bachelor’s Degree
· Working knowledge of QNXT and IntelliCred
· Prior experience with QUEST Integration Medicaid program requirements and regulation
· Prior experience with Managed Medicare Dual eligible Special Needs Plan requirements and regulations
· Advanced skills utilizing access and SQL environment.
Physical Demands/Working Conditions
· Sedentary Work: Exerting up to 20 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.
AlohaCare is committed to providing equal employment opportunity to all applicants in accordance with sound practices and federal and state laws. Our policy prohibits discrimination and harassment because of race, color, religion, sex (including gender identity or expression), pregnancy, age, national origin, ancestry, marital status, arrest and court record), disability, genetic information, sexual orientation, domestic or sexual violence victim status, credit history, citizenship status, military/veterans status, or other characteristics protected under applicable state and federal laws, regulations, and/or executive orders.