Provider Data Consultant, Network Triage and Implementation Job in Hartford, Connecticut US
The Provider Data Consultant is responsible for various activities related to the provider network database which may include any or all of the following: database maintenance, reporting and extracting data for various reports and analyses, initiating database improvement. Provider Data Consultants develop and maintain standards for database integrity and quality assurance, coordinate corrective activities to clean database and retain users, and manage communication processes with other departments regarding database improvements. Other responsibilities include conducting audits and providing feedback to reduce errors and improve processes and performance, maintaining current provider data to ensure the quality of the network, and may be responsible for representing the provider network area on company IT projects, reporting and tracking provider calls and complaints, or for the support, coordination, and production of the paper directory cycles. In this role you will be expected to:
- Anticipate customer needs and proactively develop solutions to meet them.
- Serve as a key resource on complex and/or critical issues.
- Solve complex problems and develop innovative solutions.
- Perform complex conceptual analyses.
- Review work performed by others and provide recommendations for improvement.
- Forecast and plan resource requirements.
- Authorize deviations from standards.
- May lead functional or segment teams or projects.
- Provide explanations and information to others on the most complex issues.
- Motivate and inspire other team members.
UnitedHealthcare, a UnitedHealth Group company, provides network-based health and well-being benefits and services for employers and consumers nationwide. We use our strength, diversity and innovation to improve the lives of the more than 16 million people who receive our unique blend of packages and programs. And our endless pursuit for excellence in everything we do extends to your career as well. Join us today for an inspired and purposeful mix of professional growth opportunities and personal rewards.
We're seeking a flexible self-starter with an investigative nature to fill a Provider Data Consultant independent contributor role on our Provider Network Expertise and Policy team in the area of system configuration of provider networks and other system projects. In this role you would enjoy tremendous opportunity for growth, as well as the chance to be a recognized subject-matter-expert on healthcare provider data. You would also gain exposure to all areas of the company as you focus on the following responsibilities:
- Develop configuration rules for new provider networks on NDB
- May also develop network configuration rule for Facets, NICE, Pulse, COSMOS or other platforms
- Triage and analyze new provider network initiatives identifying key impacts to operational departments and their processes
- Project manage the operational implementation of process or system enhancements
- Provide business, operational and workflow expertise into provider related system enhancements for NDB and other systems, including use of this data by claim, care management and service systems
- Support system testing activities where warranted, as part of operational implementation of new processes or system changes including writing of and review of test conditions
- Write or review training materials related to your project
- Lead cross functional business process design including development of process diagrams
- Speak at national calls to present new processes or system changes to internal departments including Network Management, NCST, NDM, CCI or other healthcare operations staff
- Drive a diverse set of special projects to completion, identifying and engaging staff from impacted departments to create and implement solutions to issues
- Troubleshoot provider data issues associated with NDB, NICE, Facets, Pulse, COSMOS or other systems which store provider data
- Create or update provider data configuration related policies and procedures; monitoring these documents through the development and approval process as part of operational implementation
Qualifications:
3 - 5 years experience with healthcare provider data and its business usage including contracting is required NDB experience required Facets, COSMOS, NICE, Pulse experience a plus Conceptual thinking capability 2 to 3 years prior professional writing experience is required, along with experience managing projects and making presentations. Willingness to handle a variety of different types of project assignments vs. a fixed role/function 2 to 3 years experience in successfully managing one or more major projects, which integrates multiple business areas or systems. Strong business partner focus. Ability to prioritize in an environment of rapid change Solid organizational and interpersonal skills Self-starter; team player; quality minded; focused; committed; work independently Able to stay committed to long-term project goals Able to direct project outcome based on long term business objectives. Candidates must have Microsoft Office skills. Prior experience with Visio and Microsoft Project preferred Bachelor's degree preferred.
UnitedHealth Group offers a full range of comprehensive benefits, including medical, dental and vision, as well as a matching 401k and an employee stock purchase plan.
Requirements:
- Undergraduate degree
- 5+ years data analysis and/or audit experience within the healthcare industry.
- 4+ years experience in managing cross functional projects and making presentations.
- 4+ years customer response/customer service experience.
- Intermediate level of proficiency in tracking, trending and reporting on metrics.
- Strong organizational and interpersonal skills.
- Advanced proficiency in MS Excel, Access and PowerPoint.
Preferred Skills:
- Experience writing policies and procedures
UnitedHealthcare, part of the UnitedHealth Group family of companies, is comprised of three specialized businesses dedicated to meeting the health care benefits needs of individuals and groups; all part of something greater, but each with a specialized focus:
UnitedHealthcare Employer Individual works with individuals, small businesses and large multi-site employers to provide innovative, affordable benefits services.
UnitedHealthcare Medicare Retirement is focused on serving Americans over the age of 50. It is the largest business dedicated to meeting the growing health and well-being needs of aging individuals in the nation, serving one in five Medicare beneficiaries through a comprehensive and diversified array of products and services through four industry-leading businesses.
UnitedHealthcare Community State provides high-quality, personalized, public-sector health care programs that help local government agencies improve health outcomes for millions of children and low-income and disabled individuals at an affordable cost.
Together, were removing the barriers that keep people from receiving the kind of quality health care that makes a difference. We focus on Integrity, Compassion, Relationships, Innovation and Performance as we empower people to achieve better health and well-being.
Come grow and thrive in our culture of innovation and ideas. Because there is no opportunity greater than the quest to help people live healthier lives.
Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.