Job details
Job type full-time
Full job description
The vendor program specialist supports program operations and internal and corporate special projects such as compiling and analyzing information for the division of insurance filings, monitoring new state and federal regulations released and responding to report requests from state medicaid programs or cmsThe specialist works with the vendor managers to ensure the clinical vendors implement and are compliant with new regulations and requirementsAdditionally, this position is responsible for managing the clinical vendor reporting and invoicing functions.
Key functions/responsibilities:
Program management
Conducts the annual clinical vendor contract performance standard gap analysis, identifying performance standard variancesWorks with clinical vendor managers to align performance standards across vendors.
Works with staff from public partnerships to identify changes to state/federal contracts and reporting requirements
Accurately explains and walks through business processes such as reporting, invoicing, and portal access during annual internal, external, and regulatory audits.
Develops and documents clinical vendor / clinical vendor management process flows, diagrams, and/or job aides to address gaps, operational efficiencies, or interdepartmental communications.
Conducts competitive vendor and vendor management analyses and researches best practices within the industry for benchmarking purposes.
Project management
Implements clinical vendor management related projects such as conducting an annual regulatory contract requirement and medicare managed care manual gap analysis, developing and maintaining the team’s website and implementing efficiencies recommended through audits, by other internal departments, or by the clinical vendor management team.
Provides project management support for new product implementations or other clinical vendor projects by:
Leading a project workgroup or sub-team
Implementing a key deliverable or work product
Setting up and managing the vendor implementation, product implementation, or project implementation work plan and action items
Reporting
Investigates and identifies ongoing regulatory reporting specifications changes for all plan product lines, and communicates the changes, timelines and impact to the internal clinical vendor management team as well as each of the clinical vendors.
Evaluates and escalates adverse trends, issues, or discrepancies to clinical vendor managers, internal business owners, and oca leadership when processing internal and regulatory reports for cms, and state contracts (nh and ma).
Establishes quality control checks to ensure zero submission errors.
Analyzes clinical vendor authorization, claims, call, provider, and utilization data.
Works with oca srBusiness process engineer and analyst to provide data for the cmo dashboard.
Works with the ncqa accreditation manager to provide clinical vendor delegation reports and materials.
Operations support
Staff clinical vendor management meetings including the clinical vendor oversight committee, joint operating committees, and regularly scheduled meetings between the clinical vendor managers and account executives, by preparing agendas and ancillary documents, drafting meeting minutes and tracking/conducting post meeting follow-up.
Organizes and maintains documentation (e.gClinical vendor calendar) and resources on department shared drive including but not limited to vendor workflows, reference guides, training documents, performance standard summaries and policiesUpdates vendor management documents (e.gClinical vendor grid) at least quarterly.
Processes clinical vendor invoices and reports.
Other vendor management duties as assigned.
Qualifications:
Education:
Bachelor’s degree in health care administration or related field, or an equivalent combination of education, training, and experience is required.
Experience:
3 or more years of experience in a healthcare setting.
Experience working on projects by using data analysis and gap analysis skills.
Competencies, skills, and attributes:
Excellent oral and written communication skills required; ability to interact within all levels of the organization and external stakeholders.
Proactive, motivated and collaborative team player.
Ability to be flexible and work independently.
Excellent organization and follow through skills.
Strong data collection, analytical, accuracy, reporting, and problem solving skills.
Ability to organize work, interpret policies, analyze and interpret data and prepare reports drawing logical conclusions.
Detail oriented, excellent proofreading and editing skills.
Experience with standard microsoft office applications (outlook, word, excel, access, powerpoint, and visio) is required.
Ability to analyze, compile, format, and present findings, data, queries, and reports to a variety of stakeholders.
Ability to manage multiple tasks and possess excellent organizational and time management skills.
Ability to work in a fast paced environment and multi task.
Ability to provide high quality customer service.
Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status.
Required skills
Required experience
