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Manager of Network Reporting | Manager in Executive Job at Meridian in Chicago IL | 5424346538

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Manager of Network Reporting

Chicago, IL

OverviewWho 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 background and culture including special events, company sports teams, potlucks, Bagel Fridays, and volunteer opportunities. A Day in the Life of a Manager of Network Reporting:This position is responsible for leading the analysis of all Meridian Illinois’s current and potential lines of business and its network of providers, specifically, the production of reports required contractually by the state, CMS and any government partner. This position will also be responsible for the reporting cadence and production as required according to the Quality Initiative goals as well as performance, and department service level expectation. In addition, Manager is responsible for the production of performance monitoring metrics and reports to respond to contractual obligations that includes, analysis, remediation, deficiency monitoring, trending of provider complaint resolution, grievance and appeals assignments and the State Complaint Portal. Responsibilities also include Managing a team of network support specialist that analyze and trend provider complaints on claims, network contract operations and member grievance against providers.ResponsibilitiesManager is also responsible to evaluating network provider needs and deficiencies to increase member enrollments thereby increasing Meridian’s market share. Improving access and availability and decreasing grievances against Meridian’s networkTrain all Network staff and network analysts on the Quest Analytics SuiteTrain all Network staff and analysts on all reporting requirement including but not limited to access and accessibility, provide disputes, grievance and appeals.Complete and provide analysis of access availability and adequacy of network reporting for all lines of business specifically reporting on state-required elements as follows:Analysis of the provider network for all provider types according to specified time and distance criteria for the following providers:Primary Care Physicians including Obstetrics and GynecologySpecialty professional providersPediatric DentistsHospitalsBehavioral Health Providers including Community Mental Health CentersDrug Use and Substance Use Providers (DASA)PharmacyHome and Community Based ServicesSkilled Nursing Facilities, Nursing Facilities and Supportive Living ProgramsReporting of geographic Distribution, tablesProvider counts of following provider types; FQHC, RHC, ERC, Hospitalist, Homebound and Family Planning ProvidersOpen and Close Panel ReportingOut of Network Utilization ReportingPrevalent modes of transportation available to enrollees, enrollees expertise to travelAccessibility and reasonable accommodation of provider locations for persons with disabilitiesPCP to member assignment ratioAssist in identifying and analyzing requests for proposals and assist in the production of reports required for proposal submission. Also responsible for report production requested by other departments, government partners including HFS and CMS and provide any reporting necessary to promote Meridian Illinois’s existing and or future book of business.Analysis of reporting on all provider enrollment reports (IMPACT, VISTAR, Credentialing etc) that affect provider network participation and create plan of action to mitigate identified participation issuesAssist in prospecting and generating leads of potential providersCreation of formal proposals and presentations working closely with the Proposal Development team, Business Development Department, Network Development Department, MeridianRx/SentinelRx team and the Communications DepartmentMaintain an in-depth knowledge of network standards in all Meridian Illinois and CMCs contract requirements and any potential new LOBsComplete and submit monthly Access Analysis and Adequacy Analysis Reports on all of Meridian Illinois’s LOBsProduce internal network reports to maintain and monitor compliance of adequacy requirement, provider directory audit results, HSAG network review response file including productivity monitoring of network response on State Provider Complaint Portal, Appeals, Grievances and Provider Claims Disputes.Convene and lead the IL Network Adequacy ReportingReport all Network Adequacy requirements to the Quarterly Quality Initiative Committee. Highlighting any deficiencies that are State and CMS -required reporting elements. Complete all HSD reports for Pharmacy, Medicare, and Medicare-Medicare PlanComplete all HSAG reporting for IllinoisWork with the Corporate Provider Services Department to correct internal dataAssist the Network Development teams at identifying gaps in network and what areas and specialties to target to fill deficienciesProduction of network reports to support local governmental relationships and inquiries from state legislation and trade associationsMonitoring and reporting of contractual reporting requirements on network adequacy, provider directory audit results, HSAG network review response file including productivity monitoring of network response on State Provider Complaint Portal, Appeals, Grievances and Provider Claims DisputesIdentifying and analyzing requests for proposals and assist in successful responses for Meridian Health Plan, and Meridian AdvantageAssist in designing business and contract models and plans for all lines of business to support local market trends and requirementsCreation of formal proposals and presentations working closely with the Communications Department, Illinois Network Operations and President/COO of Meridian ILAttend conferences and support Trade association partnership initiatives. Assist in special projects assigned by the Executive TeamPerform other duties as assignedRequirementsWhat you can bring to Meridian:Pursuit of a Bachelor’s degree or designation from the Academy for Healthcare Management (AHM), or a min of three years of State and CMS Network Adequacy, Medical Assistance Provider File, Affiliation Response File reporting with the State of Illinois background is requiredPrevious Managerial background required. Relevant background in governmental network reporting is required. Previous background in leading a team environment is preferred. Network operations in either contracting, loading, credentialing or internal network management is preferred.Extensive knowledge in reporting tools and software including Microsoft analytical toolsStrong knowledge of CMC’s mission and its operational structureGood knowledge of managed health care industryGood knowledge of CMC’s provider policies and proceduresFollow-up and follow-through skillsStrong management expertiseGreat communication, analytical and financial skillsStrong writing and presentation skillsStrong knowledge of Microsoft office suite, Ms excel, Access, Quest AnalyticsStrong leadership skillsExpertise to communicate clearly and concisely both orally and via written documentsExpertise to work as part of a team while meeting and maintaining individual goals and objectivesWhat Meridian can offer you: Ourhealthcare benefits include a variety of plans that are effective on the 1st day of employment for our new full time teammates. 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 fortuition reimbursement towards Bachelor’s or Master’s degrees. Meridian was namedDetroit'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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Manager of Network Reporting is a Executive Manager Job at Meridian located in Chicago IL. Find other listings like Manager of Network Reporting by searching Oodle for Executive Manager Jobs.