Lead Provider Data Quality Admin (Hybrid - Troy, MI) - Health Alliance Plan

GENERAL SUMMARY:

Responsible for ensuring compliance with job duties assigned as well as coordinating all internal focused provider data intelligence and analytics activities.

Produces reports related to the development of new concepts, ideas, products and services for Provider Network and Product Development initiatives. Provides compliant consistent and highly sophisticated analytical support for all initiatives in support of the Product Network Management and Product Development departments.

PRINCIPLE DUTIES AND RESPONSIBILITIES:

• Leads all Provider Data Quality compliance initiatives and ongoing maintenance projects.
• Ensures all Provider Network Management policies, procedures, and processes conform to current National Committee for Quality Assurance (NCQA) Standards, as well as relevant state and federal regulations.
• Ensures staff members are educated in departmental policies and procedures.
• Executes analysis and thoroughly understands the product portfolio. Supports the creation of recommendations and the availability and accessibility of internal provider network intelligence.
• Provides qualitative and quantitative research used to evaluate market conditions and new product initiatives. Assists the manager with the optimization of the product portfolio for meeting market needs, gaining competitive advantage, accounting for political, economic, social, and technological environment. Simultaneously managing return on investment and monitor performance.
• Leads and coordinates Provider Network and Product Management initiatives guiding multiple resources to design and execute reports which draw upon multiple data sources, identify growth opportunities, competitor offerings and product performance.
• Communicates with stakeholders’ insights, conclusions, and recommendations drawn from analysis in both written report and verbal presentation form, to direct business decision making.
• Identifies potential product adjustments, additions and deletions based on provider network intelligence and supports the product management lifecycle through analyzing product membership and performance.
• Administers provider network forecasts as well as forecasts for planning activities including membership growth and retention as it relates to the provider network, in both new areas for expansion and current service area.
• Develops and maintains reporting databases required by various functions in the organization such as Provider Network, Sales, Product Management and Marketing. Leads data analysis and provides support, including ability to design, develop, and navigate company databases and support systems, in accomplishing initiatives and business activities across the enterprise. This includes, but is not limited to access standards for CMS, NCQA, ACA and DIFS.
• Leads initiatives related to network adequacy and disruption reporting for current service area(s) and supplies intelligence for potential service area expansion opportunities.
• Gathers, compiles, analyzes, and interprets internal information to support all supported business functions using MS Access, Geo Mapping and Network Adequacy software, HAP databases and other sources, while designing and generating ad hoc and standardized reports. Fulfills work requests and complete deliverables in a timely manner while providing excellent customer service. Works collaboratively with team members.
• Participates in developing marketing plans, business plans and new marketing materials and support work groups as requested.
• Ensures HAP has signed delegation agreements that are in compliance with current National Committee for Quality Assurance (NCQA) Standards, as well as relevant state and federal regulations.
• Advises leadership of any substantial change in standards that may require the installation of new procedures/staff training.
• Perform other duties as assigned.