General Summary:
The Plan Administration Analyst reports to the Plan Administration Manager. This position is responsible for maintaining the provider databases, plan administration support, implementing and auditing contract completion, and vendor management.
- Creates and maintains fee schedule.
- Implements and audits contract completion.
- Vendor Management-We use a vendor to manage repricing contracts electronically.
- Addresses contractual questions, determines nature of inquiry, research information and determines the proper action required.
- Responsible for provider maintenance which maintains and updates all aspects of the provider databases for network providers including credentials, provider network participation, addresses, contracting status and terminations.
- W9 Management.
- Perform other duties as assigned.
General Expectations:
- Present a positive image of Consociate and Dansig at all time.
- Provide and promote the delivery of services with a prevailing attitude of respect and recognition of the personal worth and dignity of every individual whether they are a client, coworker, or supervisor.
- Communicate in a clear and concise manner, while also demonstrating receptivity through active listening.
- Identify and perform work that has not been specifically assigned, as needed.
- Adhere to established safety standards and utilizes proper techniques to avoid work related injuries.
- Continuously seek opportunities for improvement and suggest ways in which procedures/systems may be modified to accomplish tasks/goal efficiently and effectively.
- Demonstrate a teamwork philosophy by working cooperatively with others inside and outside the position’s department.
- Attend required in-service and staff meetings.
- Preserve the confidentiality of all business-sensitive information, including but not limited to that of insured groups and individuals, employees and applicants.
Service Expectations:
- Greets all people in a prompt and courteous manner. Communicates in a warm and courteous manner, making eye contact and speaking in a tone of voice that matches words.
- Offer and provide assistance whether or not the request falls within your specific job duties.
- Respond to customer requests in a timely manner, returning calls promptly and keeping them informed of delays before they ask.
- Takes appropriate steps to resolve problems to the clients satisfaction.
- Remain aware of products and services provided by Consociate.
- Project a positive, professional image when working.
Knowledge, Skills and Ability Requirements:
- Four (4) years’ experience working in managed care/healthcare environment.
- Healthcare management database experience
- Knowledge of managed care products.
- Knowledge of provider contracting.
- Knowledge of CPT,HCPCS, ICD9, revenue code and/or DRG coding practices.
- Flexibility to meet deadlines in an environment of changing priorities and workloads.
- Effective verbal and written communication skills
- Analytical skills to research and analyze data.
- Ability to work as a team.
- Strong customer service skills.
- Ability to prioritize, organize, and remain focused within established time frames.
Physical and Mental Abilities:
- Ability to perform sedentary work for extended periods of time.
- Ability to utilize personal computer (manual dexterity is required to operate a keyboard), telephone system, and communicate with a variety of customers.
- Ability to concentrate, meet deadlines, work on several projects during the same period, and adapt to interruptions.
Reporting Structure/Supervision:
- Reports to the Plan Administration Manger.
Working Conditions:
- Work is performed either onsite or remote.
- Overtime as needed may be requested.
- Travel as needed may be requested.
