Managed Care Analyst

At NorthBay Health, the Managed Care Analyst is responsible for supporting provider enrollment, contracting and contract performance initiatives. The position is responsible for supporting process improvement for all managed care activities as well as overseeing the implementation and on-going support of the Experian and EPIC contract management applications.  

PRIMARY JOB DUTIES

• Serves as a resource in credentialing standards for NCQA, CMS, Medi-Cal, medical group affiliates and health plans. 
• Monitors current regulations and enrollment guidelines for payers of all current and future healthcare services. 
• Proficient in PECOS, PAVE, CAQH, Better Doctors, MD-Staff and other credentialing and enrollment software and websites, and other tools required to enroll, credential and terminate providers.
• Supports, as needed, enrollment activities and tracks progress toward established timelines.
• Coordinates the contract configuration of Experian and EPIC contract manager applications, including updating fee schedules, newly contracted terms, and any administrative policy edits needed to accurately record expected contract reimbursements. 
• Manages with Director and Vice President contract performance reporting and prepares contract analytics for negotiations. 
• Supports the Ntracts Managed Care contract management system by loading and configuring key contract terms for all Managed Care agreements. 
• Performs special projects as assigned by Director or Vice President.
• Cross trains with other department Analysts to assist with various system maintenance, updates, etc.
• Enhances professional growth and development through educational programs or seminars.
• Maintain effective working partnerships internally and externally to support provider enrollment efforts. 
• Works independently utilizing a high level of initiative, judgement and critical thinking skills.