Location: Providence, RI
system, RIBridges. This includes coordination between State agency (business and IT) personnel, as well as vendors involved in identifying and resolving system defects. Responsibilities include Quality Control (QC) analysis and Business analysis performing quality control checks on behalf of the State to ensure that critical performance standards and KPIs are consistently met.
The Sr Systems Analyst requires strong analytical skills, attention to detail as well and solid communication skills. Responsibilities include: Perform timely QC audits of key system deliverables (i. e. Client Notices, Benefits Eligibility Determinations) to ensure they meet acceptable standards as defined by the
business Identify system failures by tracking and participating in the review of 200+ samples per month and logging issues and key findings. Conduct research to review policies and system documentation as needed in support of the audit findings.
Work directly with the business and IT to review findings and gain consensus on whether QC failures are valid. Ensure defects are logged for valid failures. Provide a thorough impact backssment of each failure and escalate any critical defects to the business. Assist the business in prioritizing defects to improve or sustain the pass rates for each Key Performance Index (KPI). Provide regular reports on QC sampling progress, pass/fail rates, and
key findings. Function as a Systems Analyst in situations requiring a liaison between Agency, IT, and Vendor resources to communicate requirements and ensure delivery and compliance.
Conduct complex and difficult technical work in systems analysis; to assist a superior in complex and difficult systems analysis; and to do related work as required. Works under the general supervision of a superior from whom are received general and specific work assignments and instructions; work is reviewed in process and upon completion for the proper application of required system analysis techniques. Conduct studies of operating departments' procedures, or the processing of data, to determine the feasibility of converting business processes or problems to automatic data processing Ascertain the nature of the project, the form and adequacy of source information, the specific work operations necessary, and the nature and form of results required.
Prepare input-output and flowcharts to show the sequence of operations and computations. Coordinate and participate in testing system updates. Develop & utilize processes to track and manage change requests and defect tickets. Create and update regular status reports of work performed. Other duties as assigned. Minimum Requirements A minimum of 6-10 years of experience with large software programs from a variety of system integrators/software vendors in the public sector is preferred; however, private sector experience will also be considered.
Bachelor's degree, preferably in computer science or information technology, or equivalent experience. Strong computer, hardware, software, and analytical skills. Ability to learn quickly and work with limited oversight and supervision. Proven ability to backss business needs and translate them into relevant solutions. Demonstrated ability to build effective partnerships with key business stakeholders, IT, and outside vendors.
Proven leadership and planning skills and a history of delivering key work products on time and with high quality. Experience with the Software Development Lifecycle (SDLC), and user acceptance testing. The ability to communicate effectively. Familiarity with Human Services programs such as Supplemental Nutrition Assistance Program (SNAP) Temporary Assistance for Needy Families (TANF) and other Social Programs (Medicaid) is a must. Required knowledge of JIRA, Excel, and Power Point.
issues and effectively communicates directly with physicians and the office staff. Identifies, pursues, and grows new membership and business opportunities. Maintains provider databases internally and externally with all CRC contracted health plans. n n Prospect Medical Holdings' ability to deliver quality, compassionate care during the unprecedented pandemic affirms the original vision of its founders.
This is the fulfillment of the hopes Prospect's founders had for the company, and proof that a clear vision, an insightful operating model, and a commitment to communities and our employees, born in the past, remains the way of the future. n n n n n n Every day, our more than 11,000 affiliated
physicians and 18,000 employees at 17 hospitals, 165 outpatient centers and 28 medical groups provide nationally recognized care in six states. Our comprehensive network of quality healthcare services is designed to offer our patients and 600,000 members highly coordinated, personalized care tailored to the unique needs of each community we serve-many of which provide essential medical services to underserved communities as safety-net hospitals.
n n Minimum Education: High School Diploma/GED required. Four (4) year college degree, preferred. n Minimum Experience: Proficiency in word, excel, pivot tables. Excellent verbal communication skills and interpersonal skills. Able to establish
rapport and interact well with individuals on all levels. Able to work with others while completing multiple tasks simultaneously and successfully.
Maintain a professional image and attitude. Exceptional customer service skills. Strong public speaking and presentation skills. Able to prioritize and organize multiple tasks. Ability to make decisions in the absence of detailed instructions and work independently or in a team environment. Experience generating strong leads for new business development opportunities including new Medicare/Medi-Medi conversions and/or IPA conversions. Minimum of 3 years of HMO/IPA/Health System experience in Provider Relations or Contracting, preferred.
Operations experience, preferred. Previous supervisory experience preferred. Must have advanced reasoning and problem solving abilities and planning skills. Ability to interpret a variety of instructions furnished in written, oral, diagram, and schedule form. Ability to speak, read, and writes English proficiently. Ability to write business correspondence. Ability to effectively present information and respond to questions from managers, employees, clients, customers and the general public. Demonstrate exceptional verbal/written/communication skills. Conducts routine visits to all providers to ensure performance compliance with revenue driven initiatives and focus on individual and IPA goals including, but not limited to the following: n n Engages in open face to face dialogue with physicians to communicate/educate important issues and updates.
n Ensures effective problem resolution and facilitate communication between CRC and Provider. n Ensures all assigned providers are compliant with company-wide initiativesn Ensures provider is well educated about CRC programs and implement specific workflows to meet initiatives and produce positive results. n Tracks and reports performance to measure results on a monthly basis and develop action plans for those non-compliant providers, with assistance from Network Manager.
n Ensures high level of participation by providers and office staff at all company events for education and training purposes. n Conducts Office Manager Meetings for assigned network physicians and develop plan to ensure high level of attendance. n Delivers and engages providers with Panel Reports in an effort to support care coordination/management and active engagement of High-Risk patients. n n In collaboration with the Network Manager, assists in identifying opportunities to achieve membership growth by developing and capitalizing on relationships with physicians and pursuing business opportunities to support company wide revenue goals including but limited to the following: n n Identifies and pursues contracts with primary care physicians who have membership growth opportunities and lead successful execution and implementation plan.
n Develops sales call plan for assigned region and achieve physician and membership goals for assigned territory. n Identifies and pursues business acquisition opportunities for senior management to explore and act as liaison between Prospect and physician through the review and implementation process.
n Identifies management opportunities with IPAs and groups and directing leads to senior management for review and consideration. n Performs/conducts Business Development functions to achieve membership growth to include: PCP recruitment, broker campouts, health plan representative and broker meetings, marketing strategies to promote growth, senior & commercial events, etc. n Actively works with network hospital(s) to identify and recruit new PCPs and high volume hospital admitters.
n Recognizes membership growth opportunities within established provider network and strategize methods to capitalize on growth via IPA consolidation, FFS Medi-Medi conversions into Managed Care product, Age in strategies, etc. n Identifies gains and losses and develop specific action plans to drive positive results for membership growth. n Tracks and trends growth and losses and report to management. n n Maintains IPA Master Provider Database and produce annual IPA Provider Directory. n n Perform the processing of new IPA Provider applications and agreements and provider terminations.
n Responsible for daily maintenance and accuracy of the IPA Provider Databasen Responsible for providing monthly IPA Provider list updates to all IPA contracted health plans and partners in format and structure required. n Process provider adds, changes and terminations using checklists to include configuration notification and health plan notification along with electronic file maintenance of contract. n Schedule and coordinate Health Plan JOCsn Maintain provider manuals for PCP and Specialists including in-service materials for network provider field visits. n Establish Cozeva and Aerial Care logins for providers and maintain records of logins provided.
n n IPA Governance - Responsible for all aspects of preparation for IPA Board and Committee and General Membership meetings including but not limited to the following: n n Work directly with RI CRC SVP on all Governance related activitiesn Ensure accurate and timely scheduling of all meetingsn Ensure agenda materials are prepared for senior leadership review at least 7 business days prior to the meetingsn Ensure agenda and materials are distributed prior to each meetingn Ensures all credentialing and recredentialing information is received timely.
n Conducts routine visits to all providers to ensure performance compliance with revenue driven initiatives and focus on individual and IPA goals including, but not limited to the following: n n Engages in open face to face dialogue with physicians to communicate/educate important issues and updates. n Ensures effective problem resolution and facilitate communication between CRC and Provider. n Ensures all assigned providers are compliant with company-wide initiativesn Ensures provider is well educated about CRC programs and implement specific workflows to meet initiatives and produce positive results.
n Tracks and reports performance to measure results on a monthly basis and develop action plans for those non-compliant providers, with assistance from Network Manager. n Ensures high level of participation by providers and office staff at all company events for education and training purposes. n Conducts Office Manager Meetings for assigned network physicians and develop plan to ensure high level of attendance. n Delivers and engages providers with Panel Reports in an effort to support care coordination/management and active engagement of High-Risk patients.
n n In collaboration with the Network Manager, assists in identifying opportunities to achieve membership growth by developing and capitalizing on relationships with physicians and pursuing business opportunities to support company wide revenue goals including but limited to the following: n n Identifies and pursues contracts with primary care physicians who have membership growth opportunities and lead successful execution and implementation plan. n Develops sales call plan for assigned region and achieve physician and membership goals for assigned territory. n Identifies and pursues business acquisition opportunities for senior management to explore and act as liaison between Prospect and physician through the review and implementation process.
n Identifies management opportunities with IPAs and groups and directing leads to senior management for review and consideration. n Performs/conducts Business Development functions to achieve membership growth to include: PCP recruitment, broker campouts, health plan representative and broker meetings, marketing strategies to promote growth, senior & commercial events, etc. n Actively works with network hospital(s) to identify and recruit new PCPs and high volume hospital admitters.
n Recognizes membership growth opportunities within established provider network and strategize methods to capitalize on growth via IPA consolidation, FFS Medi-Medi conversions into Managed Care product, Age in strategies, etc. n Identifies gains and losses and develop specific action plans to drive positive results for membership growth. n Tracks and trends growth and losses and report to management. n n Maintains IPA Master Provider Database and produce annual IPA Provider Directory. n n Perform the processing of new IPA Provider applications and agreements and provider terminations.
n Responsible for daily maintenance and accuracy of the IPA Provider Databasen Responsible for providing monthly IPA Provider list updates to all IPA contracted health plans and partners in format and structure required. n Process provider adds, changes and terminations using checklists to include configuration notification and health plan notification along with electronic file maintenance of contract. n Schedule and coordinate Health Plan JOCsn Maintain provider manuals for PCP and Specialists including in-service materials for network provider field visits.
n Establish Cozeva and Aerial Care logins for providers and maintain records of logins provided. n n IPA Governance - Responsible for all aspects of preparation for IPA Board and Committee and General Membership meetings including but not limited to the following: n n Work directly with RI CRC SVP on all Governance related activitiesn Ensure accurate and timely scheduling of all meetingsn Ensure agenda materials are prepared for senior leadership review at least 7 business days prior to the meetingsn Ensure agenda and materials are distributed prior to each meetingn Ensures all credentialing and recredentialing information is received timely.
n
