Job description

The Company: AlohaCare is a local, non-profit health plan serving the Medicaid
and Medicare dual eligible population.
We provide comprehensive managed care to qualifying health plan members
through well-established partnerships with quality health care providers and
community-governed health centers. Our mission is to serve individuals and
communities in the true spirit of aloha by ensuring and advocating access to
quality health care for all. This is accomplished with emphasis on prevention
and primary care through community health centers that founded us and continue
to guide us as well as with others that share our commitment. As Hawaii’s
third-largest health plan, AlohaCare offers comprehensive prevention, primary
and specialty care coverage in order to successfully build a healthy Hawaii. The Company: AlohaCare employees share a passion for helping Hawaii’s most
underserved communities. This passion
for helping and caring for others is internalized and applied to our employees
through a supportive and positive work environment, healthy work/life balance,
continuous communication and a generous benefits package. AlohaCare’s leadership empowers and engages its employees through
frequent diversity, recognition, community, and educational events and programs.
AlohaCare has a strong commitment to support Hawaii’s families and reinforces a
healthy work/home balance for its employees. Because AlohaCare values honesty,
respect and trust with both our internal and external customers, we encourage
open-door, two-way communication through daily interactions, employee events
and quarterly all-staff meetings. AlohaCare’s comprehensive benefits package
includes low cost medical, dental, drug and vision insurance, PTO program, 401k
employer contribution, referral bonus and pretax transportation and parking
program. These employee-focused efforts contribute to a friendly,
team-oriented culture which is positively reflected into the communities we
serve. The
Opportunity: The Provider Data Management Supervisor is accountable for the end to
end accuracy of AlohaCare’s provider data and maintenance of supporting
documentation for its credentialed and contracted provider network. The
Supervisor oversees a team of staff who accomplish intake, data entry, records
maintenance, system configuration, reporting and problem solving. This team
operates with aloha in their daily interactions with provider office personnel
and its responsiveness is critical to maintaining positive relationships for
the organization. Close oversight of the validity and accuracy of provider data
is central to assuring that our members have access to needed care. The
Provider Data Management Supervisor reports to the Sr. Manager of Credentialing
and Provider Data Management. Primary
Job Duties and Responsibilities: ·
Oversees, plans, assigns and evaluates the
work of department staff, including: o Initiate
new records in credentialing system & input demographic updates o Enter
contracted provider data into core system & configure contractso Maintain
rosters and provider affiliations for contracted groups, IPAs, ACOs & other
umbrella entitieso Setup
provider accounts for provider portal, EFT & other internal systemso Verification
of non-credentialed provider typeso Administration
of the PCP enhancement programo Create/update
provider data & contract designations in core systemo Research/adjust
contract setup to address claims processing issueso Provide
contract information & setup status updates to other departmentso Conduct
ongoing provider data validation and quality assurance auditso Develop,
execute & validate provider data reports to support regulatory requirements
accreditation standards and provider network adequacy analysiso Develop
and execute provider data processing reports for measurement to performance
metrics o Maintain
configuration of credentialing system & relationship with system vendoro Provides
technical expertise to staff as well as establishes workflows, quality validation
and communication structures.o Develops
and maintains Policies and Procedures for Provider Data Management work.o Assists
with recruitment and selection of new staff.o Provides
training, mentoring, periodic assessments of staff competencies, perform annual
reviews, enforces disciplinary activities related to job performance and
discharge duties when applicable. o Develops
and/or monitors work plans and determines priorities.o Responsible
for end to end accuracy and completeness of provider data and supporting
documentationo Resolves
issues encountered during daily operations and determines standards for problem
resolution.o Serves as
subject matter expert on provider data, related processes and systems used to
meet regulatory, contractual and accreditation requirements.o Responsible
to maintain AlohaCare’s confidential information in accordance with AlohaCare
policies, and state and federal laws, rules and regulations regarding
confidentiality. Employees have access to AlohaCare data based on the
data classification assigned to this job title.o Availability
to work extended hours on a case-by-case basis to address business needs.o Other
duties as assigned. Required
Competencies & Qualifications: ·
Associates Degree·
Two to three years’ experience in managed or
health plan provider contract management systems. ·
Minimum of two (2) years of supervisory
experience·
Advanced skills using Microsoft programs;
Word, Excel and Outlook·
Advance skills with Adobe programs·
Cultural diversity, sensitivity and excellent
people skills·
Exceptionally organized, process thinker able
to oversee efficiency and accuracy of work performed by assigned team members·
Strong listening skills·
Positive attitude and energy·
Ability to provide clear, concise and
effective training·
Excellent verbal and written communication
skills, including interpersonal interaction·
Flexibility and adaptability to changing
priorities·
Demonstrated ability to review and quality
check the accuracy of data entry and reports ·
Ability to think and prioritize work tasks
independently Preferred
Competencies & Qualifications: ·
Bachelor’s Degree ·
Working knowledge of QNXT and IntelliCred·
Prior experience with QUEST Integration
Medicaid program requirements and regulation·
Prior experience with Managed Medicare Dual
eligible Special Needs Plan requirements and regulations·
Advanced skills utilizing access and SQL
environment. Physical
Demands/Working Conditions ·
Sedentary Work: Exerting up to 20 pounds of
force occasionally and/or a negligible amount of force frequently or constantly
to lift, carry, push, pull, or otherwise move objects. Sedentary work involves sitting most of the
time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing
are required only occasionally and all other sedentary criteria are met. AlohaCare is committed to providing equal
employment opportunity to all applicants in accordance with sound practices and
federal and state laws. Our policy
prohibits discrimination and harassment because of race, color, religion, sex
(including gender identity or expression), pregnancy, age, national origin,
ancestry, marital status, arrest and court record), disability, genetic
information, sexual orientation, domestic or sexual violence victim status,
credit history, citizenship status, military/veterans status, or other
characteristics protected under applicable state and federal laws, regulations,
and/or executive orders.

Job Type: Full-time

Pay: $61,000.00 - $78,000.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Day shift

Ability to commute/relocate:

• Honolulu, HI 96814: Reliably commute or planning to relocate before starting work (Required)

Experience:

• managed or healthplan provider contract management systems: 2 years (Required)
• supervisory: 2 years (Required)

Work Location: One location

offroadmanagementgroup.com is the go-to platform for job seekers looking for the best job postings from around the web. With a focus on quality, the platform guarantees that all job postings are from reliable sources and are up-to-date. It also offers a variety of tools to help users find the perfect job for them, such as searching by location and filtering by industry. Furthermore, offroadmanagementgroup.com provides helpful resources like resume tips and career advice to give job seekers an edge in their search. With its commitment to quality and user-friendliness, offroadmanagementgroup.com is the ideal place to find your next job.