Meridian

  • Vendor Specialist

    Job Location US-MI-Detroit
    Job ID
    2018-7163
    Category
    Utilization Management
    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 Vendor Specialist:

    This position is responsible for supporting vendors that are involved in the Utilization Management program. The Vendor Specialist will be responsible for direct interaction with vendors and representing these vendors while working with internal departments.

    Responsibilities

    • Provide timely response and resolution to all vendor inquiries
    • Complete authorization entry for vendor services when appropriate
    • Monitor SharePoint, Fax Queues and MCS Work Queues and correct any issues resulting from these monitoring activities
    • Assist with the completion of vendor reports
    • Assist with the review of monthly and quarterly vendor compliance reporting
    • Prepare and review vendor audit universe(s) for CMS submission
    • Conduct audits on vendor activities
    • Participate in Joint Operating Committee (JOC) meetings with vendors
    • Gather and analyze vendor performance metrics
    • Act as vendor liaison between internal departments
    • Identify and implement process improvement opportunities
    • May be required to work weekends, holidays and/or observed holidays as requested by leadership

    Qualifications

    What you can bring to Meridian:

    • Associate’s degree is required
    • Bachelor’s degree or Fellow designation from the Academy of Healthcare Management (AHM) is preferred
      Experience:
    • A minimum of one to two years experience as a Utilization Management Specialist or one to two years of related health industry experience is required

    • Knowledge of managed care and Michigan Medicaid guidelines
    • Thorough knowledge of the authorization process
    • Understanding of NCQA, URAC, CMS or general accreditation requirements for Utilization 
    • Excellent verbal and written communication skills
    • Basic computer skills
    • Telephone service skills

    What Meridian can offer you:

    • Our healthcare benefits include a variety of 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 Meridian employees are eligible for tuition reimbursement towards Bachelor’s or Master’s degrees.
    • Meridian 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

    MSTR

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