Analyst – Medicaid Network Operations
Employment Information
Report this job
Job expired or something wrong with this job?
Job Description
Contract Coordinator Analyst in Medicaid Network Operations supporting provider contracts and compliance. Collaborating with network management and internal departments for effective operations.
Responsibilities:
- Perform thorough reviews of all incoming contractual documents to ensure completeness and accuracy; work with contracting staff to obtain missing or incomplete documents as needed
- Work with national provider data service team to load newly contracted providers to the provider record database in a timely manner
- Audit updated provider records to ensure the correct changes were made to the database; submit corrections as needed
- Maintain the master repository of participating provider contracts, load newly executed provider agreements to the repository
- Manage contracting team email box; appropriately respond and triage of both internal and external messages to the appropriate parties. Respond to emails within established turnaround times
- Research and respond to inquiries from providers and internal staff regarding contractual matters such as a provider’s participating status in the Aetna Better Health of Illinois provider network
- Send out provider welcome packets to newly contracted providers
- Support internal contract auditing processes as requested
- Compile, summarize and report on the Health Plan’s compliance with contract submission rules and exception requests, communicating on at minimum, a monthly basis
- Assist with miscellaneous claims projects/audits and reviewing contracts and plan documents
- Ensures compliance of health plan, corporate, state, and federal regulations
- Escalate issues, as necessary, to management in a timely manner
- Work with members of Network Development and internal department staff to identify process improvement opportunities
- Perform other duties as assigned
Requirements:
- 2-5 years of professional work experience, 1 year in the healthcare industry
- Experience working in TriZetto QNXT
- Experience with medical terminology
- Experience working with Microsoft Office Suite
- Proven ability to manage multiple workflows, prioritize effectively, and meet deadlines
- Strong written and verbal communication skills, with the ability to convey complex information clearly
Benefits:
- medical, dental, and vision coverage
- paid time off
- retirement savings options
- wellness programs
- other resources, based on eligibility
Similar Jobs
NOC Engineer I – Outage Management
NOC Engineer monitoring Lumos’s 100% fiber-optic broadband network and coordinating outage resolution. Troubleshooting IP, Transport, Voice, GPON, and core network issues on the overnight 3rd shift.
Network Operations Center (NOC) Analyst – Day Shift
VNOC Technician role focusing on monitoring and responding to network activity and incidents. Collaborate with internal teams at Vantage Point Solutions to ensure network reliability and performance.
Senior Associate, Network Operations
Senior Associate managing the provider network and data integrity for Diverge Health. Responsible for roster operations and analytics to support payer relationships and growth.
Responsable d'exploitation, Airbnb
Responsable d'exploitation pour gestionnaires immobiliers chez ALB Conciergerie. Gestion de logements sur les plateformes de location courte durée et optimisation des revenus des propriétaires.
Responsable d'exploitation Airbnb – Conciergerie en France
Responsable d'exploitation chez ALB Conciergerie gérant des logements sur des plateformes de location courte durée. Optimisation des annonces, gestion des réservations, et développement du portefeuille client.
NOC Engineer III
NOC Engineer III at Boldyn Networks ensuring reliability in network infrastructure for clients. Responsible for troubleshooting, network documentation, and liaison between engineering group and client staff.
Network Operations Manager
Network Operations Manager at Kimball Electronics providing leadership and support for network hardware and software. Collaborating with IT team on operational projects and improvements in network processes.
NOC Supervisor
NOC Supervisor overseeing NOC agents and technical support operations for RealPage. Ensuring monitoring and incident response in a 24/7/365 environment.
NOC Technician
NOC Technician responsible for monitoring and troubleshooting network infrastructure for healthcare clients. Working in a fast-paced MSP environment to ensure optimal performance and security.
VP Network Operations – Chief of Staff
VP, Network Operations & Chief of Staff overseeing network operations and shared services at Health Network One. Focus on building frameworks, improving processes, and driving strategic initiatives.
NOC Engineer
NOC Engineer ensuring continuous availability and performance of systems for a global communication platform. Collaborating with R&D to support partners worldwide in a remote-first environment.
3PL Network Operations, Manager
3PL Network Operations Manager overseeing end-to-end operational performance and process ownership of warehousing and distribution in North America. Ensuring compliance, safety, and cost-effective services across 3PL partners.
Global Network Operations NOC II
Global Network Operations NOC II Technician responsible for surveillance and repair of Ethernet and IP networks. Requires experience with Juniper or Cisco equipment and excellent customer service.
NOC Engineer
NOC Engineer monitoring client infrastructure and responding to incidents in a remote role. Collaborating with teams to ensure network operations and client satisfaction.
Junior NOC Engineer
Network Operations Center Engineer monitoring and troubleshooting network infrastructure for True Zero Technologies. Collaborating with teams to ensure reliable performance and operational continuity.
NOC Engineer
NOC Engineer I responsible for incident response according to standard procedures in a cybersecurity firm. Supporting Managed Services Solutions with maintenance and remediation efforts.
Network Operations Specialist
Network Operations Specialist providing first line of defense troubleshooting for Viamedia staff. Monitoring technical operations and maintaining run rate reports while ensuring high-quality service delivery.
Network Ops Architect, Observability
Network Operations and Observability Architect designing observability architecture for large-scale Telco consolidation program. Collaborating with cross-domain architects and leading monitoring strategy implementation.
Senior Consultant – Network Operations Backbone
Specialized Consultant managing network operations and maintenance systems at TIM. Focusing on application and validation of diverse telecom solutions and protocols skills.
Network Ops & Observability Architect
Network Operations and Observability Architect leading target-state monitoring strategy for large-scale consolidation program at a US-based Telco. Design observability architecture and minimize alert fatigue.