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Provider Reporting Analysis amp Compliance Specialist Network Opns Specialist - Work locations of

Baltimore, MD

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Provider Reporting, Analysis, & Compliance Specialist (Network Opns Specialist) - Work locations, of

Job #685189325
Work locations, office based: Baltimore, MD or Philadelphia, PA
Under direct supervision, responsible for routine data imports, extractions, database creation, maintenance, and reporting. Analyzes trends, identifies areas for improvement, and verifies results for accuracy. Supports compliance requests which may involve strict timelines. Relies on instructions and pre-established guideline to perform functions of the job. Assists in the development, implementation, and maintenance of business solutions. May act as a liaison between different departments. Will manage delegated group rosters and support internal auditing requirements. Should be able to utilize independent judgment and discretion when pulling data and delivering updates.
Will support compliance requests related to CMS
May support PDV team with reporting functions
Will support all provider reporting termination requests from internal customers
Will support all expansion initiatives
Manage claims reporting requests
Will manage delegated group requirements
Other duties as may be required
Bachelor's degree required.
Proficient knowledge of Medicare Advantage terminology
Strong skills in analytical/problem solving
This position will require proficiency with Microsoft Excel, Access, and Outlook.
Knowledge of SQL programming and an understanding of Medicare regulatory requirements is preferred.
Strong project management skills.
Excellent communication and interpersonal skills.
Primary Location:
Other Locations:
United States-Pennsylvania-Philadelphia
Work Locations:
3700 O'Donnell St Duck Bldg Baltimore 21224
Provider--Network/Data Mgmt
Employee Status:
Individual Contributor
Job Type:
Job Level:
Day Job
Job Posting:
Jun 11, 2018, 12:02:26 PM
Qualified applicants will be considered for employment without regard to age, race, color, religion, national origin, sex, sexual orientation, gender identity, disability, veteran status. Need an accommodation? Email: ~~~
Updated 06/13/2018

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