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Job Location: Rancho Cucamonga, CA
Job Detail:
Position
Analyst II – Provider Services Administration
Description
Under direction of the Provider Delegation Manager Analyst II will lead the team of Analysts and Coordinators in the non-clinical design, structure, and management of the Provider Services FDR Oversight Program. Responsibilities include lead in the development, implementation, and management of FDR Oversight activities for the Provider Services Department; identify, maintain and manage the provider reporting requirements and tracking of performance standards for continuous support and evaluation including analysis of the current processes to ensure adherence to regulatory and business requirements. The position will also be responsible for a variety of complex assignments that are delegated by Management in terms of objectives rather than specific instructions. The Analyst II is responsible for supporting the Manager in providing leadership, training, and ensuring quality and completeness of all required or directed activities.
- Serves as Lead Analyst in supporting Provider Delegation Manager and Provider Services Department as follows:
- Lead in planning and coordination of all department functions as requested
- Act as primary liaison between department and other department
- Lead team of Analysts in all required Delegation Oversight reporting needs
- Serve as expert Analyst in department for all IPA reporting requirements
- Responsible for leading in assigned department projects, ensuring date and analysis requests are completed timely, accurately and presented in a way that meets the needs of requesting department or committee. Analyst II must be able to assess departmental and committee requests and solicit feedback from requestors regarding any crucial decision points that are necessary to complete requests accurately and timely. To do this effectively, the Analyst II must have knowledge of the data sources available for reporting and must have clear understanding of company business operations to apply appropriate criteria and methodology to meet requestor’s needs. It is also necessary to understand how department deliverables, including standard reports, ad-hoc requests, studies, analyses, and recommendations that can affect business operations at THE company
- Responsible for managing monthly IPA monthly performance reports and summaries which are presented in Delegation Oversight Committee. Also leads in the deployment and tracking of all IPA performance reports and Corrective Action Plans
- Act as Subject Matter Expert for the Compliance Program Effectiveness (CPE) First-Tier Entity, and Internal Auditing and Monitoring universes.
- Act as Subject Matter Expert for NCQA readiness
- Responsible for managing of semi-annual and annual Delegation Oversight Audit program and annual audit summaries for presentation in Compliance Committee and to Board of Directors.
- Coordinate, prepare and monitor special projects and reports as required. Assist Provider Delegation Manager in development and maintenance of internal and external policies and procedures related to Delegation Oversight and IPA delegated activities
- Responsible for writing of training materials, working in team setting with other Provider Services Team Members as well as subject matter experts within the company to develop training materials and enhance existing resources
- Responsible for compilation, data analysis and summary report collection for all IPA performance
- Serve as Lead in the development of systems and processes to support operational strategies that lead continuous improvement in IPA performance
- Responsible for maintaining a comprehensive knowledge of all regulatory and company requirements, including Policies and Procedures, DOFR, IPA reporting requirements, related to Delegation Oversight and IPA delegated responsibilities
- Assist Provider Delegation Manager with management of all non-clinical Delegation Oversight activities including intake, review and logging and distribution of required reporting; development, distribution and tracking of all IPA communications, administration of Annual Delegation Oversight Audits, Regulatory Audits, monthly IPA Performance Reports, Delegation Oversight Committee packet preparation, incentive programs, and CAP administration
Requirements
- Must have three (3) or more years in relative health plan delegation and regulatory oversight related experience with strong ability in report writing and analysis and working with external delegated entities. Experience with regulatory audit submission requirements and preparation.
- Bachelor’s degree from an accredited institution required.
- Yes, must have a valid California Driver’s License.
- Requires a solid understanding of DHCS, DMHC and CMS regulatory requirements and processes related to effective auditing and monitoring of delegated entities. Knowledge of delegated entity contractual requirements. Advanced knowledge of research and analysis of regulatory contracts with the health plan. APL and DLP analysis and implementation into business requirements and processes. Thorough Knowledge of delegation oversight committee functions and responsibilities.
Additional Information
- Hybrid Monday adn Friday WFH and Tuesday- Thursday onsite
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