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Functions as the liaison between Corporate Care/EHS and HR for all work related injuries and employee return to work clearances; responsible for maintaining data in Agility for quarterly DART reports, and preparing/distributing annual OSHA logs and monthly reports including Safety, Safe Patient Handling, Infection Control and PIC.
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Participate on the following institutional teams: Emergency Response Team; Safety Committee; Global Education; Health Care Task Force, Institutional Review Board, General Data Protection Regulation (GDPR) team, Driver Review Board, Bookstore Advisory Committee, and Staff Leadership.
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Certified Provider Credentialing Specialist (CPCS) certification - PreferredExperience working within a health plan, managed care organization, provider operated healthcare environment or Third-Party Administrator (TPA)/Business Process Outsourcing (BPO) - RequiredExtensive knowledge of computers and related software applications, such as Word, PowerPoint, Excel, Project - RequiredPrior supervisory or management experience – Required.
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Divisional Operational Risk and Data Management: including Divisional Operational Risk, electronic discovery and ESI management (EEM), divisional records information management (RIM), third-party risk management (including TPA process for legal vendors)Work as a peer-to-peer partner with the Division’s Chief of Staff to, among other things, set priorities and allocate resources in alignment with corporate objectives and the strategic plan.
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Responsible for data maintenance and analytics within Third-Party Administrator (TPA) software as well as analytics within Allina's data mart across both inpatient and outpatient settings.
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Assisting with collecting and analyzing data needed to support Liability Claims trend identifications, KPI, project and process metrics, TPA oversight/management, unassigned inventory, and other areas determined necessary.
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Responsible for managing claims in Agility and ensuring all proper documentation is scanned to employee charts; reviews, updates and distributes weekly claims review logs to TPA, clinicians, Directors and senior leadership as directed.
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This will involve management of split billing system, third-party administrative (TPA) software(s), maintaining policies and procedures, conducting audits on prescriptions for compliance and enhancement, confirming inventory is represented appropriately within software(s), and maintaining all lists associated with 340B Program participation and maintenance.
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Basic knowledge of data acquisition and analysis tools such as Siemens Test. Lab, Head Acoustics and Vector tools (CANalyzer/CANape). Develop detailed test plans and conduct NVH assessments, incorporating modal analysis, Frequency Response Functions (FRF), Operating Deflection Shapes (ODS), and Transfer Path Analysis (TPA.
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The Manager, Credentialing Operations collaborates with Provider Data Management (PDM), Market Operations, Shared Service team, and our external business partners to monitor operations, resolve service barriers, develop solutions to improve effectiveness, and identify continuous improvement initiatives to increase service and operational level agreements.
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Serve as an expert in the administration and maintenance of credentialing and provider data management systems, including the Council for Affordable Quality Healthcare (CAQH), Credentialing System and proprietary claim systems.
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Ability to analyze, develop and perform quality assurance and validation exercises related to Part B and Part D IRA MFP drug claim data and adjustment activities to encompass drug manufacturer, wholesaler, PBM, dispenser, TPA, and health plans ecosystem.
Full-timeExpandApply NowActive JobUpdated 22 days ago - UpvoteDownvoteShare Job
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Collaborate and maintain cross-functional working relationships with team members of multiple business units; Claims Third-party Administrators (TPA), Programmers, and approved vendors to analyze and correct data quality errors.
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Assist underwriting, premium audit, stat reporting and other groups as needed with questions involving TPA claims data. We are currently seeking an energetic self-starter who can succeed with minimal guidance and support to fill the Third Party Administrator (TPA) Data Analyst position and join the TPA Data Management Unit (DMU.
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Review and oversight of quarterly fund closes based on data received from the Third Party Administrator (TPA), which includes review of related support for all balance sheet and income statement accounts.
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