Contract Qc Analyst - Phoenix, United States - TriWest Healthcare Alliance

TriWest Healthcare Alliance

Verified Company

Phoenix, United States

2 weeks ago

Posted by:

Mark Lane

beBee recruiter

Description

Profile:

We offer remote work opportunities (AK, AR, AZ, CA, *CO, *HI, IA, ID, IL, KS, LA, MD, MN, MO, MT, NE, NV, NM, NC, ND, OK, OR, SC, SD, TN, TX, UT, VA/DC, *WA, WI & WY only).Our Department of Defense contract requires US citizenship and a favorably adjudicated DOD background investigation for this position.

Veterans, Reservists, Guardsmen and military family members are encouraged to apply
Job Summary
The Contract Quality Control Analyst supports the Supervisor of Provider Systems & Quality.

Performs quality control activities on provider contract and data records that have been entered and processed by the Provider Data and Contracting teams.

Ensures the integrity and quality of the provider contract elements, verifying the accuracy of the data and contracting information. Coordinates the internal review and audit process including assisting in monitoring production and quality goals and standards for performance. Identifies process improvements to enhance contracting data and staff quality standards.

Education & Experience

Required:

High school diploma or G.E.D.
3 years' experience working with contracting or provider data
Experience in interpreting policies, monitoring compliance, or developing contract management processes
Working knowledge of the provider contracting process

Preferred:

Bachelor's degree in Business, Health Care Administration, Data Analysis, or related field
Lead role over a process
Experience with Provider Data Management Systems

Key Responsibilities

Maintains all audit tools for internal and external audits.
Assists in conducting Daily/Weekly/Monthly audits of contract and data staff.
Monitors accuracy of the provider contract and data by conducting periodic audits.
Collaborate with multiple business partners including but not limited to Contracting Administration, Corporate Compliance, Claims Administration, and Legal to create strategies for contract templates while being proactive in preventing noncompliance.
Manages executed contracts and amendments across multiple channels of the healthcare business.
Develops and monitors quality reports and communications using contracting and provider data management systems.
Assists in producing trend reports to improve workflow efficiency and system functions to recommend possible solutions to management.
Assists with resolving data quality issues by identifying, documenting, and communicating quality issues.
Assists with performing root cause analysis.
Performs other duties as assigned.
Regular and reliable attendance is required.

Competencies

Commitment to Task:
Ability to conform to established policies and procedures; exhibit high motivation.

Communication / People Skills:
Ability to influence or persuade others under positive or negative circumstances; adapt to different styles; listen critically; collaborate.

Coping / Flexibility:

Resiliency in adapting to a variety of situations and individuals while maintaining a sense of purpose and mature problem-solving approach is required.

Empathy / Customer Service:
Customer-focused behavior; helping approach, including listening skills, patience, respect, and empathy for another's position.

Information Management:
Ability to manage large amounts of complex information easily, communicate clearly, and draw sound conclusions.

High Intensity Environment:
Ability to function in a fast-paced environment with multiple activities occurring simultaneously while maintaining focus and control of workflow.

Organizational Skills:
Ability to organize people or tasks, adjust to priorities, learn systems, within time constraints and with available resources; detail-oriented.

Problem Solving / Analysis:
Ability to solve problems through systematic analysis of processes with sound judgment; has a realistic understanding of relevant issues.

Technical Skills:

Healthcare and/or Managed Care experience; working knowledge of Medicare requirements, URAC standards and State and Federal Regulations; working knowledge of the TriWest policies and procedures; current knowledge of Contract Management, Contract Negotiation and Templates, Internal Process Improvement, and medical terminology; knowledge of contracting and provider data management systems; proficient with Word, Excel, and data management systems.

Working Conditions

Working Conditions:

Availability to work any shift
Works within a standard office environment, with mínimal travel
Department of Defense security clearance required

Company Overview:

Taking Care of Our Nation's Heroes.

It's Who We Are. It's What We Do.
Do you have a passion for serving those who served?

Join the TriWest Healthcare Alliance Team We're On a Mission to Serve
Our job is to make sure that America's heroes get connected to health care in the community.

At TriWest Healthcare Alliance, we've proudly been on that impo