Location: Durham, NC
Duration: 2 Months
- Ongoing analysis of provider data to assure quality and adherence to defined procedures.
- Data discrepancy reporting and resolution.
- Provider Rosters and Medicare Corporate Provider return mail.
- Create and maintain Medicare Provider Contract, Configuration and issue tracking and status reporting.
- Translation of CMS Medicare Provider Data requirements into reports of these functions to ensure performance standards meet all CMS Directory, HSD Table, Claims and Audit requirements as well as applicable State and Contractual requirements.
- Collaborate with Provider Network Management, Provider Data Management, Provider Data Integrity, Claims and any/all other Departments.
- Development of department workflows, policies and procedures as well as training material, recurring and complex ad-hoc reports and data sets.
- This position will also demonstrate proficiency with trending and performance analysis, recognizing patterns and possible variables that impact performance.
- Identification of operational gaps, risks and issues, opportunities for efficiencies and strategies for process improvement.
- Development of short and long term solutions, monitoring plans and mechanisms; implementation and UAT for change management and process improvement.
- Ability to develop and understand business process flows and impact to performance results.
- Elaborate findings, insights and communicate such to management, internal and external customers.
- Express status of performance through summaries, including changes in performance and impact to performance standards