Meridian

  • Corporate Provider Services Analyst

    Job Location US-MI-Detroit
    Job ID
    2018-5296
    Category
    Provider & Data Analytics
    Business Line
    CMC Corporate
  • Overview

    Who we are:

    Meridian, a WellCare Company, is part of a national network of passionate leaders, achievers, and innovators dedicated to making a difference in the lives of our members, our providers and in the healthcare industry.

     

    We provide government-based health plans (Medicare, Medicaid, and the Health Insurance Marketplace) in Michigan, Illinois, Indiana, and Ohio.  As a part of the WellCare Family of companies, we deliver healthcare excellence to millions of members nationwide.

     

    Our associates work hard, play hard, and give back. Meridian associates enjoy an exceptional experience and culture including special events, company sports teams, potlucks, Bagel Fridays, and volunteer opportunities.

     

    A Day in the Life of a Corporate Provider Services Analyst:

     

    This position is responsible for research and analysis of all Caidan Managements current and potential lines of business with an emphasis on expansion of Caidan Management Company through new customer development and increased market share for Meridian Health Plan, Meridian Advantage and MeridianRx.  This position also provides support activities as well as assisting in reporting and specific projects for the Corporate Provider Services Department.

    Responsibilities

    • Complete and provide analysis of access availability reporting for all Caidan Management current and potential lines of business
    • Assist in identifying and analyzing requests for proposals and assist in successful responses for Meridian Health Plan, Meridian Advantage and MeridianRx
    • Assist in Prospecting and generating leads of potential providers
    • Creation of formal proposals and presentations working closely with the Communications Department, Director of Provider Network Development and Director of Corporate Provider Services and Credentialing
    • Complete and submit weekly production reporting for the Corporate Provider Services and Credentialing departments
    • Conduct weekly auditing of the integrity of data entered into the Managed Care System, including duplicate entries
    • Identify and promptly correct any data entry errors or inconsistencies within the Managed Care System
    • Complete routine auditing of provider files including applications, contracts and facility site reviews in electronic and hard copy form, as well as the exporting of provider data and coordinating with the Credentialing and Finance departments
    • Ensuring MHP’s credentialing standards are maintained as well as maintaining accurate provider data through update forms and claim information
    • Reporting of contracted providers through spreadsheets and provider directories
    • Performing and preparing analysis of provider data for committees and meetings
    • Responsible for the oversight of the creation of various reports used to ensure compliance with state and federal requirements
    • Assure compliance with requirements of all national and State regulatory agencies, including NCQA, URAC, CMS or general accreditation
    • Assist in special projects assigned by the Executive Team

    Qualifications

    • High School Diploma is required
    • Bachelor’s degree or Fellow designation from the Academy for Healthcare Management (AHM) is preferred
    • Thorough knowledge of CMC’s mission and its operational structure
    • Thorough knowledge of managed health care industry
    • Thorough knowledge of CMC’s provider policies and procedures
    • Follow-up and follow-through skills
    • Strong organizational skills
    • Excellent communication, analytical and financial skills
    • Strong writing and presentation skills.
    • Strong knowledge of MS office, Excel, Access
    • Ability to communicate clearly and concisely both orally and via written documents
    • Ability to work as part of a team while meeting and maintaining individual goals and objectives
    • Leadership capabilities, self-motivation and outstanding ability to sell
    • Oral and written communication skills
    • Current driver’s license and willingness to travel
    • Computer skills with MS Office, databases, Internet searches, etc.

    What Meridian can offer you:

    • Our healthcare benefits include a variety of PPO plans that are effective on the first day of employment for our new full-time team members.
    • Opportunity to work with the industry’s leading technologies and participate in unique projects, demonstrations, conferences, and exclusive learning opportunities.
    • Meridian offers 401k matching that is above the national average.
    • Full-time MHP employees are eligible for tuition reimbursement towards Bachelor’s or Master’s degrees.
    • Meridian Health Plan was named Detroit's #1 Fastest Growing Company by Crain's Magazine, so it is a great time to get involved with Meridian. 

    Equal Opportunity Employer

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