Working independently, the Provider Information Management Systems Specialist Senior is responsible for supporting the Manager of Provider Information and Provider Information staff as necessary. The candidate functions as a technical and procedural resource, develops, revises and delivers training to meet the needs of departmental employees. Represents the department across the organization as a subject matter expert (SME) and highlights challenges and technical requirements to help inform management of changes to departmental work. The position requirements also include: completing routine audits across multiple complex systems to ensure compliance and data integrity with department standards and for the use of external facing provider directories and information; triaging and escalating system issues, process design improvement opportunities, and quality improvement opportunities for the department. This person assist with conversion to new systems, works with cross interdepartmental teams to understand how existing systems can be integrated into new systems and/or upgrades, is conversant in TAHPMaster, Diamond, Health Rules Payor, Cactus and any other system supporting provider data for the organization. Knowledge of products and tiering of providers as well as the various methods for aligning providers by product (e.g., Medicare, Medicaid, Commercial and others) to assist in conversion and or maintenance needs of all systems.

 

Key Responsibilities/Duties - What You Will Be Doing

• Responsible for thorough understanding of all systems supporting provider information areas within the plan. Acts as the SME on interdepartmental teams, advises others of system ability, trains team and supports training with quality checks and review, conveys escalated issues as needed to management, triages issues as they occur and resolves or escalates to management as needed.
• Works across all provider data systems, e.g., TAHPMaster, HRP, Diamond, Cactus. The various requests and changes to provider information, include but are not limited to: Demographic information Provider payment information including group affiliations New or additional IPA affiliations New or additional hospital affiliations Provider panel restrictions/closures Provider coverage arrangements Provider Terminations Provider Category Changes Product participation changes Tiering
• Consistent quality data input is critical to ensure the information is accurately reflected in the multiple systems.
• Collaborate with other data integrity efforts across all adjacent departmental teams and conduct regular audits to evaluate Provider Information data integrity across all related systems. Identify potential training needs. Create audit summaries for review and follow-up by Provider Information supervisor and management.
• Thorough understanding of directory data elements as well as billing data and ensures correct hierarchy of data in systems to support network.
• Develop, update and maintain Provider Information Training documentation for newly created or updated policies and procedures. In collaboration with others on the team, coordinate all aspects of training of new processes for Provider Information Specialists. Design quality review processes and measurement tools to be used by Manager to evaluate learning/retention of staff. Conduct retraining of Provider Information Specialists on any new or revised workflows or as deemed appropriate by department management. Serve as a resource to the team and many areas across the organization to answer technical and/or procedural questions.
• Participate, as necessary, in company defined initiatives related to provider information and maintenance as a subject matter expert.
  
• Other duties as assigned.
  

Qualifications - What You Need To Perform The Job

EDUCATION: (Minimum education & certifications required)

• B.A/B.S. or equivalent in health care or related field required.

EXPERIENCE: (Years of experience)

• At least five years’ experience in a health care setting.
• Extensive experience related to database management systems.
• Candidate must possess strong interpersonal, organizational, presentation, verbal and written communication skills.
• Must be able to present training content in a motivational manner, exercising patience and creativity.
• Ability to listen, problem-solve and simultaneously manage multiple projects and priorities.

SKILL REQUIREMENTS: (Include interpersonal skills)

• Requires comprehensive knowledge of health plan provider information/data requirements and related issues.
• Individual must possess initiative, judgment, exceptional organizational skills and the keen attention to detail necessary to operate in a complex, multi-faceted environment.
• Requires excellent interpersonal and presentation skills to work with a diversity of individuals. Must have demonstrated analytical ability and problem-solving skills.
• Must be able to work cooperatively as a team member. Excellent interpersonal skills required.

Commitment to Diversity, Equity & Inclusion

Point32Health is committed to making diversity, equity, and inclusion part of everything we do—from product design to the workforce driving that innovation. Our DEI strategy is deeply connected to our core values and will evolve as the changing nature of work shifts. Programming, events, and an inclusion infrastructure play a role in how we spread cultural awareness, train people leaders on engaging with their teams and provide parameters on how to recruit and retain talented and dynamic talent. We welcome all applicants and qualified individuals, who will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.

Who We Are

Point32Health is a leading health and wellbeing organization, delivering an ever-better personalized health care experience to everyone in our communities. At Point32Health, we are building on the quality, nonprofit heritage of our founding organizations, Tufts Health Plan and Harvard Pilgrim Health Care, where we leverage our experience and expertise to help people find their version of healthier living through a broad range of health plans and tools that make navigating health and wellbeing easier.

We enjoy the important work we do every day in service to our members, partners, colleagues and communities.

This job has been posted by Ignyte AI on behalf of Point32Health. Ignyte AI is committed to the fundamental principle of equal opportunity and equal treatment for every prospective and current employee. It is the policy of Ignyte AI not to discriminate based on race, color, national or ethnic origin, ancestry, age, religion, creed, disability, sex and gender, sexual orientation, gender identity and/or expression, military or veteran status, or any other characteristic protected under applicable federal, state or local law.

Req ID: R7121

Posted On: Tuesday, September 12, 2023