Analyst II - Provider Services Administration
Job Requisition ID:
9785Position Summary/PositionUnder 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.
Major Functions (Duties and Responsibilities)1.
Serves as Lead Analyst in supporting Provider Delegation Manager and Provider Services Department as follows:
a.
Lead in planning and coordination of all department functions as requestedb.
Act as primary liaison between department and other IEHP departmentc.
Lead team of Analysts in all required Delegation Oversight reporting needsd.
Serve as expert Analyst in department for all IPA reporting requirementse.
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 IEHP 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 IEHPf.
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 Plans2.
Act as Subject Matter Expert for the Compliance Program Effectiveness (CPE) First-Tier Entity, and Internal Auditing and Monitoring universes.
3.
Act as Subject Matter Expert for NCQA readiness4.
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.
5.
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 activities6.
Responsible for writing of training materials, working in team setting with other Provider Services Team Members as well as subject matter experts within IEHP to develop training materials and enhance existing resources7.
Responsible for compilation, data analysis and summary report collection for all IPA performance8.
Serve as Lead in the development of systems and processes to support operational strategies that lead continuous improvement in IPA performance9.
Responsible for maintaining a comprehensive knowledge of all regulatory and IEHP requirements, including Policies and Procedures, DOFR, IPA reporting requirements, related to Delegation Oversight and IPA delegated responsibilities10.
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 administrationMajor Functions (Duties and Responsibilities) Cont11.
Assist in updating communication and posting updated to Reporting Templates and Letter Templates12.
Assist Delegation Oversight Manager in development of interdepartmental committee and sub-committee reporting requirements13.
Demonstrate commitment to support IEHP's strategic priorities to become 5-Star Health Plan and incorporate LEAN principles into daily work.
Take lead role in department in spearheading process improvement efforts through active participation in RIE's, development of standard work, metric report development and maintenance, and participation in departmental huddles.
Supervisory ResponsibilitiesLeading:
SelfExperience QualificationsMust 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.
Preferred ExperienceEducation QualificationsBachelor's degree from an accredited institution required.
Preferred EducationProfessional CertificationProfessional LicensesDrivers License RequiredYes, must have a valid California Driver's License.
Knowledge RequirementRequires 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.
Skills RequirementCan perform an intermediate level of Excel and Word, strong ability to lead a group of Team Members, multi-task, prioritize, and stay organized in an ambiguous work environment.
Requires effective verbal and written communication skills that can build trust and accountability with IEHP.
Abilities RequirementRequires the unique ability to effectively collaborate and manage relationships across the organization and with external partners.
Ability to manage multiple projects of varying complexity, priority levels and deadlines.
Ability to work with minimal direction.
Commitment to Team CultureThe IEHP Team environment requires a Team Member to participate in the IEHP Team Culture.
A Team Member demonstrates support of the Culture by developing professional and effective working relationships that include elements of respect and cooperation with Team Members, Members and associates outside of our organization.
Working ConditionsLong hours may be required to meet project or compliance deliverables.
Work will require occasional local travel to delegate facilities in Riverside and San Bernardino counties and occasional travel for industry conventions or training.
Position is eligible for Hybrid work location upon completing the necessary steps and receiving HR approval.
All IEHP positions approved for telecommute or hybrid work locations may periodically be required to report to IEHP's main campus for mandatory in-person meetings or for other business needs as determined by IEHP leadership.
Work Model LocationHybridPhysical RequirementsKeyboarding:
Traditional - FREQUENTLYKeyboarding:
10-Key - FREQUENTLYKeyboarding:
Touch-Screen - FREQUENTLYHearing:
One-on-One - FREQUENTLYCommunicate:
Information/ideas verbally - FREQUENTLYSitting - CONSTANTLYIndoors - FREQUENTLYLighting - CONSTANTLYNear Visual Acuity - FREQUENTLYDevelop and maintain positive work relationships - CONSTANTLYRegular contacts:
co-workers, supervisor - FREQUENTLYRegular contacts:
recurring clients - FREQUENTLYRapid Pace of work - FREQUENTLYControl of work pace - FREQUENTLYPace of work with faster/slower work periods - FREQUENTLYMemory - FREQUENTLYUnderstand and follow direction - FREQUENTLYRegular and reliable attendance - CONSTANTLYA reasonable salary expectation is between $70,012.
80 and $89,273.
60, based upon experience and internal equity.
Inland Empire Health Plan (IEHP) is the largest not-for-profit Medi-Cal and Medicare health plan in the Inland Empire.
We are also one of the largest employers in the region, designated as Great Place to Work.
With a provider network of more than 5,000 and a team of more than 3,000 employees, IEHP provides quality, accessible healthcare services to more than 1.
5 million members.
And our Mission, Vision, and Values help guide us in the development of innovative programs and the creation of an award-winning workplace.
As the healthcare landscape is transformed, we're ready to make a difference today and in the years to come.
Join our Team and make a difference with us! IEHP offers a competitive salary and stellar benefit package with a value estimated at 35% of the annual salary, including medical, dental, vision, team bonus, and state pension plan.
Recommended Skills Computer Sciences Scripting Software Engineering Information Technology Infrastructure Server (Computer Science) Estimated Salary: $20 to $28 per hour based on qualifications.
9785Position Summary/PositionUnder 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.
Major Functions (Duties and Responsibilities)1.
Serves as Lead Analyst in supporting Provider Delegation Manager and Provider Services Department as follows:
a.
Lead in planning and coordination of all department functions as requestedb.
Act as primary liaison between department and other IEHP departmentc.
Lead team of Analysts in all required Delegation Oversight reporting needsd.
Serve as expert Analyst in department for all IPA reporting requirementse.
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 IEHP 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 IEHPf.
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 Plans2.
Act as Subject Matter Expert for the Compliance Program Effectiveness (CPE) First-Tier Entity, and Internal Auditing and Monitoring universes.
3.
Act as Subject Matter Expert for NCQA readiness4.
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.
5.
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 activities6.
Responsible for writing of training materials, working in team setting with other Provider Services Team Members as well as subject matter experts within IEHP to develop training materials and enhance existing resources7.
Responsible for compilation, data analysis and summary report collection for all IPA performance8.
Serve as Lead in the development of systems and processes to support operational strategies that lead continuous improvement in IPA performance9.
Responsible for maintaining a comprehensive knowledge of all regulatory and IEHP requirements, including Policies and Procedures, DOFR, IPA reporting requirements, related to Delegation Oversight and IPA delegated responsibilities10.
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 administrationMajor Functions (Duties and Responsibilities) Cont11.
Assist in updating communication and posting updated to Reporting Templates and Letter Templates12.
Assist Delegation Oversight Manager in development of interdepartmental committee and sub-committee reporting requirements13.
Demonstrate commitment to support IEHP's strategic priorities to become 5-Star Health Plan and incorporate LEAN principles into daily work.
Take lead role in department in spearheading process improvement efforts through active participation in RIE's, development of standard work, metric report development and maintenance, and participation in departmental huddles.
Supervisory ResponsibilitiesLeading:
SelfExperience QualificationsMust 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.
Preferred ExperienceEducation QualificationsBachelor's degree from an accredited institution required.
Preferred EducationProfessional CertificationProfessional LicensesDrivers License RequiredYes, must have a valid California Driver's License.
Knowledge RequirementRequires 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.
Skills RequirementCan perform an intermediate level of Excel and Word, strong ability to lead a group of Team Members, multi-task, prioritize, and stay organized in an ambiguous work environment.
Requires effective verbal and written communication skills that can build trust and accountability with IEHP.
Abilities RequirementRequires the unique ability to effectively collaborate and manage relationships across the organization and with external partners.
Ability to manage multiple projects of varying complexity, priority levels and deadlines.
Ability to work with minimal direction.
Commitment to Team CultureThe IEHP Team environment requires a Team Member to participate in the IEHP Team Culture.
A Team Member demonstrates support of the Culture by developing professional and effective working relationships that include elements of respect and cooperation with Team Members, Members and associates outside of our organization.
Working ConditionsLong hours may be required to meet project or compliance deliverables.
Work will require occasional local travel to delegate facilities in Riverside and San Bernardino counties and occasional travel for industry conventions or training.
Position is eligible for Hybrid work location upon completing the necessary steps and receiving HR approval.
All IEHP positions approved for telecommute or hybrid work locations may periodically be required to report to IEHP's main campus for mandatory in-person meetings or for other business needs as determined by IEHP leadership.
Work Model LocationHybridPhysical RequirementsKeyboarding:
Traditional - FREQUENTLYKeyboarding:
10-Key - FREQUENTLYKeyboarding:
Touch-Screen - FREQUENTLYHearing:
One-on-One - FREQUENTLYCommunicate:
Information/ideas verbally - FREQUENTLYSitting - CONSTANTLYIndoors - FREQUENTLYLighting - CONSTANTLYNear Visual Acuity - FREQUENTLYDevelop and maintain positive work relationships - CONSTANTLYRegular contacts:
co-workers, supervisor - FREQUENTLYRegular contacts:
recurring clients - FREQUENTLYRapid Pace of work - FREQUENTLYControl of work pace - FREQUENTLYPace of work with faster/slower work periods - FREQUENTLYMemory - FREQUENTLYUnderstand and follow direction - FREQUENTLYRegular and reliable attendance - CONSTANTLYA reasonable salary expectation is between $70,012.
80 and $89,273.
60, based upon experience and internal equity.
Inland Empire Health Plan (IEHP) is the largest not-for-profit Medi-Cal and Medicare health plan in the Inland Empire.
We are also one of the largest employers in the region, designated as Great Place to Work.
With a provider network of more than 5,000 and a team of more than 3,000 employees, IEHP provides quality, accessible healthcare services to more than 1.
5 million members.
And our Mission, Vision, and Values help guide us in the development of innovative programs and the creation of an award-winning workplace.
As the healthcare landscape is transformed, we're ready to make a difference today and in the years to come.
Join our Team and make a difference with us! IEHP offers a competitive salary and stellar benefit package with a value estimated at 35% of the annual salary, including medical, dental, vision, team bonus, and state pension plan.
Recommended Skills Computer Sciences Scripting Software Engineering Information Technology Infrastructure Server (Computer Science) Estimated Salary: $20 to $28 per hour based on qualifications.
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