Managed Care Analyst

Job Summary

Under supervision of Director, Provider Relations oversees workflow and coordination of Provider Relations projects that support Beaumont Health facilities & affiliated physicians with both Managed Care plans and the Employee Health Plan Provider Network. Assist Sr. Provider Relations Representatives as appropriate to complete implementation of key Managed Care & Beaumont Health Employee Health Plan related projects and communications, both written and oral. Ensure tracking of key data provider data elements are accurate and kept current. Planning and organizational skills are extremely important in this position and must demonstrate a strong commitment with respect to exceeding customer expectations as well as resolving issues with a high level of tact and understanding. Must interact effectively as a team member and demonstrate a capacity for management of multiple projects and shifting deadlines.

Essential Functions

• Track and maintain provider data in Managed Care Contracting system software.
• Work with third party payers on behalf of providers to help facilitate the enrollment and participation process. Work with payers on roster generation and audits to ensure both parties have accurate, current information on participating providers and required data elements.
• Educate, and facilitate the process, for providers to become an Oakwood ACO member. Track current Oakwood ACO membership in Managed Care Contracting system software.
• Work with providers to explain payer requirements for enrollment and process to become a participating provider, including distribution of any provider material as needed. Communicate updates and changes of known payer processes that will impact providers.
• Assist with maintaining the Employee Health Plan Provider Network via routine reconciliations of contracted providers and communicating any needed changes with current Third Party Administrator (TPA).
• Assist in ensuring provider satisfaction through education and training, problem resolution and provider relations activities.
• Identify issues and coordinate problem resolution for physicians, hospitals and their support staff. Investigate and facilitate resolution of managed care related issues; involves complex and unusual issues requiring creative problem-solving skills.
• Assist with communication of critical information to providers, including financial models, contractual terms/, obligations and payer plan updates through bulletins, newsletters and other media.
• Aid System Director and Sr. Provider Relations Rep. in oversight and completion of special projects; performs all other duties as assigned.
• Aid Sr. Financial Analyst with special projects as needed.

Qualifications

Required

• Associate's Degree in Business or related field.

• 1 year of relevant experience A minimum of one year experience in third-party provider enrollment.

About Corewell Health

As a team member at Corewell Health, you will play an essential role in delivering personalized health care to our patients, members and our communities. We are committed to cultivating and investing in YOU. Our top-notch teams are comprised of collaborators, leaders and innovators that continue to build on one shared mission statement - to improve health, instill humanity and inspire hope. Join a nationally recognized health system with an ambitious vision of continued advancement and excellence.

• Forceful Pinch > 2 lbs: Seldom
• Finger/Hand Dexterity: Frequently
• Visual Acuity
  [None = No; Seldom = Yes]: Seldom