Provider Payment Analyst

Profile

We have an opportunity to join the Alliance as the Provider Payment Analyst in the Provider Services Department. We are recruiting for one position and it can be filled in any of our three Alliance offices in California: Merced, Salinas or Scotts Valley.
WHAT YOU'LL BE RESPONSIBLE FOR
Reporting to the Provider Services Contracts Manager, you will:
Lead and participate as a member of workgroups and committees designed to develop and monitor provider reimbursement related activities and enhance provider payment initiatives
Lead the planning, analysis, implementation and management of provider reimbursement, incentive, and system related projects and programs
Conduct and coordinate research and analysis to resolve complex reimbursement, incentive, and system related provider inquiries
ABOUT THE TEAM
The Provider Services Department is a professional, collaborative and fun group dedicated to their mission of promoting member wellness through the availability of qualified, accessible, and responsive providers. The Provider Payment Analyst position is part of the Provider Contracts team who manages our contractual relationship with providers and serves as a key stakeholder in provider payment-related initiatives.
THE IDEAL CANDIDATE
Some knowledge of provider networks in Santa Cruz, Monterey and Merced counties
Some experience working with health plan claims payments systems, such as Health Solutions Plus (HSP) and/or Essette
Is organized
Is comfortable leading and meetings or workshops and can tactfully facilitate if disagreement arises
Enjoys research and analysis
WHAT YOU'LL NEED TO BE SUCCESSFUL
To read the full position description, and list of requirements click here
Knowledge of:
The California Medi-Cal program
The principles and practices related to provider payment processes
Knowledge, and proficiency, in research, analysis and reporting methods
Ability to:
Understand, interpret and apply contract language, complex laws, legislative and regulatory directives, policies, standards, and guidelines
Demonstrate strong analytical and research skills, identify and troubleshoot issues, identify alternative solutions, and make recommendations for action
Analyze and interpret data and define options utilizing various reporting methods
Prepare reports, provide analytical conclusions, and clearly document and summarize complex issues
Lead, facilitate and coordinate meetings and workgroup activities
Education and Experience:
Bachelor’s degree in Business, Public Administration, Economics, Healthcare or a related field
Five (5) years of project management or analysis experience in a Medi-Cal or managed care environment, which included some experience working with provider payment processes; or an equivalent combination of education and experience may be qualifying
OTHER DETAILS
While this position is connected to one of our Alliance offices, we are in a fully telecommute work environment right now due to the COVID-19 pandemic. The interview and on-boarding process for this position will be completed remotely
This position
may
require onsite presence when our offices re-open, which will be no sooner than February 1, 2022. Onsite presence will most likely be on a part-time basis, but is dependent on business needs
Additionally, all positions at the Alliance are required to meet these minimum qualifications
OUR BENEFITS
Medical, Dental and Vision Plans
Ample Paid Time Off
11 Paid Holidays per year
401(a) Retirement Plan
457 Deferred Compensation Plan
Robust Health and Wellness Program
EV Charging Stations
And many more
ABOUT US
We are a group of over 500 dedicated employees, committed to our mission of providing accessible, quality health care that is guided by local innovation. We feel that our work is bigger than ourselves. We leave work each day knowing that we made a difference in the community around us.
Join us at **MEMBERS ONLY**SIGN UP NOW***. (the Alliance), where you will be part of a culture that is respectful, diverse, professional and fun, and where you are empowered to do your best work. As a regional non-profit health plan, we serve over 377,000 members in Santa Cruz, Monterey and Merced counties. To learn more about us, click here
At this time the Alliance does not provide any type of sponsorship. Applicants must be currently authorized to work in the United States on a full-time, ongoing basis without current or future needs for any type of employer supported or provided sponsorship.

Company info

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