On Belay Health Solutions

• Perform in-depth data analysis to identify trends, patterns, and opportunities within healthcare datasets • Write complex SQL queries to extract, manipulate, and analyze large datasets • Develop analytical reporting solutions and dashboards that support operational and financial decision-making • Communicate trends, variances, and performance results to technical and non-technical stakeholders • Partner with business teams to understand needs and deliver data-driven recommendations • Create and maintain process documentation for data workflows, reporting logic, and methodologies • Perform monthly refresh validations, variance identification, and root cause analysis across reporting and analytic outputs • Investigate data anomalies, reconcile discrepancies, and independently troubleshoot reporting issues • Support the standardization and ongoing improvement of reporting logic and methodologies • Work independently to prioritize and manage multiple analytic requests in a fast-paced environment • Perform other duties as assigned

About the role We are seeking a detail-oriented and organized Provider Network Associate - Payor Contracting to join our team. This role is essential for managing the enrollment process and maintaining accurate provider roster information for payor and government programs. Your primary focus will be on ensuring accurate and up-to-date records, facilitating communication between internal teams and payor partners, and assisting in compliance efforts. This position is vital for optimizing our provider network and enhancing operational and financial efficiency for payor contracts. What you'll do - Facilitate the enrollment of healthcare providers in various payor and government programs, including Medicare, Medicaid, Medicare Advantage and Commercial payors. - Prepare and submit enrollment applications, ensuring all documentation is complete and compliant with payor requirements. - Track the progress of enrollment applications and follow up as necessary to ensure timely processing. - Maintain and update the provider roster for all contracted payors and government programs, ensuring accuracy and compliance with policies. - Conduct regular audits of provider data to verify completeness, including licenses, certifications, and demographic information. - Assist in onboarding and training new staff and/or providers on provider enrollment processes, compliance requirements, and best practices. - Generate reports on enrollment status and roster metrics to assist in compliance monitoring and decision-making. - Prepare for audits by maintaining organized and accurate documentation of enrollment and roster records. - Work closely with credentialing, contracting, and billing teams to gather necessary information and resolve discrepancies related to provider enrollment. - Develops and enforces best practices for provider data management, helping to standardize processes across the organization. - Provides insights through regular reporting on provider enrollment status, compliance metrics, and roster accuracy, aiding in strategic decision-making. - Act as the primary liaison for payors regarding enrollment inquiries and status updates. Communicate any changes in provider status, additions, or terminations as required. - Serve as the primary point of contact for providers regarding enrollment and roster management inquiries, providing timely and accurate information. - Identify opportunities for streamlining enrollment and roster management processes and implement best practices to enhance efficiency and accuracy. - Address issues related to provider enrollment, such as discrepancies in documentation or changes in provider status, ensuring timely resolution. - Perform other duties as assigned. Qualifications - Bachelor’s degree in Healthcare Administration, Business, or a related field preferred. - 3+ years of experience in provider enrollment, roster management, value-based and government programs. - Superior understanding of healthcare regulations, credentialing processes, and enrollment requirements for payor and government programs. - Excellent organizational skills with a strong attention to detail and accuracy - Strong verbal and written communication skills, with the ability to collaborate effectively with cross-functional teams. - ACO, MSO experience - Multi-State or National payor experience - Strong knowledge of healthcare reimbursement methodologies and value-based payment models. Benefits - Innovative, revolutionary environment - Great culture with a strong sense of mission and community - Eleven (11) Paid Holidays - Lavish PTO accrual - Advancement opportunities & professional skills training - Strong referral bonus program - And more! Compensation - We offer a competitive base salary ranging from $32 - $35/hour, depending on experience. Come join us on the journey to better and more affordable healthcare! We are an equal opportunity employer. Employment selection and related decisions are made without regard to age, race, color, national origin, religion, sex, disability, sexual orientation, gender identification, or being a qualified disabled veteran or qualified veteran of the Vietnam era or any other category protected by Federal or State law.

• Regularly reviewing and assessing the effectiveness of the Compliance Program. • Taking sufficient steps to document the efforts of On Belay and its ACOs to meet its compliance obligations, advising management and the Compliance Committee and the Boards about achieving compliance and implications of non-compliance. • Implementing and overseeing written compliance, privacy and data sharing policies and procedures and the Code of Conduct. • Chair and be responsible for committee materials for the Policy Committee and the Compliance Committee. • Taking steps to communicate the Compliance Program, HIPAA, privacy and data sharing policies and procedures to employees and contractors of the On Belay and its ACOs, including overseeing the On Belay policy database and the NAACOS manuals site. • Developing or supporting and implementing a compliance, privacy and security awareness education and training program, including overseeing the training database and maintaining records of trainings in conjunction with Human Resources. • Appropriately publicizing, monitoring and responding to the mechanisms for reporting suspected instances of non-compliance, including those requirements required by law. • Implementing and overseeing the process of exclusion checks for employees, board members and participating providers, including overseeing the exclusion database. • Implementing and overseeing the conflict of interest process in coordination with the General Counsel, including overseeing the disclosure database. • Assisting the General Counsel with the review of Business Associate Agreements and monitoring the contract database, including developing or modifying relevant templates and processes . • Regular monitoring (at least bi-weekly) all relevant CMS portals for audits and CMS actions, reviewing newsletters and informational posts, attending meetings with CMS representatives, forwarding relevant dates for posting on the ACO Master Calendars, and coordinating responses and corrective action plans with the General Counsel and Chief Operating Officer. • Coordinating with the vCISO and IT Department on privacy or security issues that impact compliance and privacy, including phishing campaigns and security awareness training. • Assisting the Payor Department and/or General Counsel with process for Medicare Advantage compliance, including development of Payor Addendums and annual attestations. • Developing, implementing and monitoring annual Audit Work Plans for each On Belay entity approved by the Compliance Committee and the respective ACO Board(s) (This includes all subcomponents for each On Belay ACO and other On Belay entities), including conducting audits each quarter and reporting findings as appropriate to Leadership, the Compliance Committee and/or ACO and other Boards • Reporting regularly to the Compliance Committee and ACO Boards and at least annually to the System Board or more frequently, as appropriate. • Receiving, documenting and investigating reports of potential compliance and privacy violations and non-compliance with the Compliance Program, policy or applicable laws and regulations, which may include engaging internal and external resources to assist with investigations, including legal counsel. • Assisting with development of corrective action and mitigation plans when non-compliance with the Compliance Program or violations of policies and procedures or applicable laws are identified. • Assisting On Belay in making a good faith report of non-compliance with the Compliance Program or Applicable Law in conjunction with and advised by legal counsel. • Ensuring that those who participate in an investigation may do so without fear of retaliation. • Responding appropriately and timely to compliance questions. • Sharing compliance information with the ACOs, such as the results of internal audits or investigations, when such are relevant to the operation of any ACO program. • Upon consultation with legal counsel, ensuring appropriate notice to CMS of any required notifications. • The Compliance Officer shall have direct access to the On Belay Boards, senior management, and legal counsel, as well as the ACO Boards. • The Compliance Officer will ensure they have the resources necessary to effectively design, implement and monitor the Compliance Program. • The Compliance Officer may delegate these responsibilities and activities to internal and external staff and resources, provided that the Compliance Officer shall remain responsible for oversight of all delegated activities and responsibilities. • For the purposes of the ACOs, the Corporate Compliance and Privacy Officer will not be legal counsel for any ACO and shall be accountable to each ACO Board. • Perform other duties as assigned.