We are a not-for-profit offering Medicaid, Medicare Advantage, and Individual & Family health plans in Washington state.
Performance and Network Compliance Analyst
Location
Washington
Posted
12 days ago
Salary
$73.0K - $111.7K / year
Seniority
Senior
Job Description
Performance and Network Compliance Analyst
Community Health Plan of Washington
• 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. • 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.
Job 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.
- Have experience in project coordination and office support, preferred.
Benefits
- Medical, Prescription, Dental, and Vision
- Telehealth app
- Flexible Spending Accounts, Health Savings Accounts
- Basic Life AD&D, Short and Long-Term Disability
- Voluntary Life, Critical Care, and Long-Term Care Insurance
- 401(k) Retirement and generous employer match
- Employee Assistance Program and Mental Fitness app
- Financial Coaching, Identity Theft Protection
- Time off including PTO accrual starting at 17 days per year.
- 40 hours Community Service volunteer time
- 10 standard holidays, 2 floating holidays
- Compassion time off, jury duty
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