What are the responsibilities and job description for the Network Policy Analyst Insurance - Start Next Week position at TEKsystems c/o Allegis Group?
Job Details
Description
The Network Policy Analyst is responsible for leading resolution of Fee Reviews initiated by network providers to ensure compliance with requirements set forth by the Insurance Commission Division. The Network Policy Analyst is also responsible for participation in the successful planning, design, and management of provider network to comply with compliance standards and adequacy requirements that range in scope from short term, medium level importance to full coordination of Corporate Tactical Initiatives and Regulatory/Compliance Requirements.
Lead the Fee Review Process which includes analyzing and explaining complex policy and reimbursement issues to providers, Professional Reimbursement and leadership
Prepare cases for Operations Management Committee decision making and for formal Fee Review Committee (practicing physicians) review, communicating with physicians (both verbally and in writing) regarding the outcome and rationale behind decisions and tracking all actions taken to respond to the inquiry to ensure compliance with company's contractual obligations with physicians and to support commitments made to the Insurance Commission Division.
Network Design, Management and Execution
Participate in the assessment and establishment of network plan to monitor compliance with federal and state regulations, government program rules and sub-regulatory guidance and internal policies and standards. This includes but is not limited to:
Identify available networks in applicable lines of business (commercial, Medicaid, and Medicare) and programs, and conduct network analysis to establish access and compliance requirements.
Assess needs and develop project plan(s) including phases, work plans, deliverables and expected outcomes.
WEST: #prioritywest
#westpriority25
Pay and Benefits
The pay range for this position is $33.65 - $36.06/hr.
Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following:
Medical, dental & vision
Critical Illness, Accident, and Hospital
401(k) Retirement Plan - Pre-tax and Roth post-tax contributions available
Life Insurance (Voluntary Life & AD&D for the employee and dependents)
Short and long-term disability
Health Spending Account (HSA)
Transportation benefits
Employee Assistance Program
Time Off/Leave (PTO, Vacation or Sick Leave)
Workplace Type
This is a hybrid position in Honolulu,HI.
Application Deadline
This position is anticipated to close on Mar 5, 2025.
About TEKsystems:
We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company.
The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.
The Network Policy Analyst is responsible for leading resolution of Fee Reviews initiated by network providers to ensure compliance with requirements set forth by the Insurance Commission Division. The Network Policy Analyst is also responsible for participation in the successful planning, design, and management of provider network to comply with compliance standards and adequacy requirements that range in scope from short term, medium level importance to full coordination of Corporate Tactical Initiatives and Regulatory/Compliance Requirements.
Lead the Fee Review Process which includes analyzing and explaining complex policy and reimbursement issues to providers, Professional Reimbursement and leadership
Prepare cases for Operations Management Committee decision making and for formal Fee Review Committee (practicing physicians) review, communicating with physicians (both verbally and in writing) regarding the outcome and rationale behind decisions and tracking all actions taken to respond to the inquiry to ensure compliance with company's contractual obligations with physicians and to support commitments made to the Insurance Commission Division.
Network Design, Management and Execution
Participate in the assessment and establishment of network plan to monitor compliance with federal and state regulations, government program rules and sub-regulatory guidance and internal policies and standards. This includes but is not limited to:
Identify available networks in applicable lines of business (commercial, Medicaid, and Medicare) and programs, and conduct network analysis to establish access and compliance requirements.
Assess needs and develop project plan(s) including phases, work plans, deliverables and expected outcomes.
WEST: #prioritywest
#westpriority25
Pay and Benefits
The pay range for this position is $33.65 - $36.06/hr.
Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following:
Medical, dental & vision
Critical Illness, Accident, and Hospital
401(k) Retirement Plan - Pre-tax and Roth post-tax contributions available
Life Insurance (Voluntary Life & AD&D for the employee and dependents)
Short and long-term disability
Health Spending Account (HSA)
Transportation benefits
Employee Assistance Program
Time Off/Leave (PTO, Vacation or Sick Leave)
Workplace Type
This is a hybrid position in Honolulu,HI.
Application Deadline
This position is anticipated to close on Mar 5, 2025.
About TEKsystems:
We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company.
The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.
Employers have access to artificial intelligence language tools (“AI”) that help generate and enhance job descriptions and AI may have been used to create this description. The position description has been reviewed for accuracy and Dice believes it to correctly reflect the job opportunity.
Salary : $34 - $36
