Medical Management Vendor Relations Analyst

Ensures that program deliverables, documentation, and reporting are complete and meets contractual, compliance, and accreditation requirements.

Develops data templates and submission forms.

• Maintains program documentation for auditing purposes.
• Analyzes business issues, including but not limited to new services, contract deliverables, enhancements, etc.
• Troubleshoots workflow issues as well as member / provider complaints and recommend solutions to management and internal departments.
• Reviews status reports to ensure projects progress on schedule within prescribed guidelines. Modify plans as required. Prepares project reports for management, partners, or others as required.
• Identifies and implements opportunities for process improvement in workflows and infrastructure operations. Initiate change and evaluate impact.
• Program interaction / Committee involvement

Presents vendors' UM program description, program evaluation, and delegation oversight audit reports to HMSA's cross-functional committees

• Meets regularly with vendor's operational areas to assist with oversight of the vendor program and services
• Provides coordination and guidance to other departments and external resources in managing work to support efficient program operations.
• Leads coordination of internal cross-departmental meetings
• Provides training and consultation to vendor staff on an as-needed basis
• Subject matter expertise on program compliance

Facilitates quarterly UM file reviews with Medical Director's guidance

• Acts as a liaison between vendors and HMSA departments for various audit activities
• Coordinates with vendors to ensure timely and accurate reporting of UM decisions as required by state and federal agencies
• Provides subject matter expertise in evaluating vendors' compliance with NCQA UM standards
• Prepares vendors' documentation in consultation with Quality Improvement department for submission to NCQA during re-accreditation surveys
• Performs all other miscellaneous responsibilities and duties as assigned or directed

LI-Hybrid

• Bachelor's degree and three years of work experience or equivalent combination of education and experience.
• Working knowledge / skills in project management / coordination
• Working knowledge in issues identification, data collection, and validation
• Strong oral and written communication skills with the ability to provide information to management, providers, vendors, and other employees.
• Basic working knowledge in Microsoft Office applications, including Word, Excel, and Outlook.
• Working knowledge of database and spreadsheet programs.