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Network Administration Analyst

4 months ago

Des Moines, United States Wellmark Full time
Company Description

Why Wellmark: We are a mutual insurance company owned by our policy holders across Iowa and South Dakota, and we've built our reputation on over 80 years' worth of trust. We are not motivated by profits. We are motivated by the well-being of our friends, family, and neighbors-our members. If you're passionate about joining an organization working hard to put its members first, to provide best-in-class service, and one that is committed to sustainability and innovation, consider applying today

Learn more about our unique benefit offerings here.

Want to know more? You can learn about life at Wellmark here.

Job Description

Help us lead change and transform Wellmark's business

The health care industry is changing, and Wellmark is working to help change it for the better. We recognize that our members deserve health care with a focus on quality. We also recognize that health care is complex. We've embarked on a journey to support our members use and navigate the health care system in order to help them make clear, informed decisions, and we're also ensuring that we take a team-centric approach when working with and in support of our members. The work that our diverse business and care teams are doing in collaboration with our health care partners will create these changes, all while working to minimize health care costs.

Use your strengths as Network Administration Analyst at Wellmark

Analysts will conduct provider credentialing, recredentialing, contracting, maintenance, and payment activities for Wellmark provider networks. This individual will ensure providers meet credentialing and contracting criteria and are set up for accurate provider reimbursement for claims adjudication.

Ideal candidates possess health care related experience and have worked within production-based environments where quality goals, accuracy, time management, and attention to detail are crucial to success. Top candidates will have provider contracting and/or credentialing experience.

Qualifications

Required:
  • High School Diploma or GED
  • 1+ years of experience working in a fast-paced environment where production and/or quality goals were measured. Demonstrated commitment to timeliness, prioritization, accuracy, and attention to detail as it applies to process, guidelines, etc.
  • Experience working in a health care related environment, such as provider office setting, insurance operations, provider network administration, contracting, credentialing, or similar area.
  • Strong written and verbal communication skills with the ability to clearly and concisely communicate information to stakeholders.
  • Ability to develop professional customer relationships by listening, understanding, anticipating, and providing solutions to customer needs.
  • Strong problem solving skills.


Additional Information

a. Conduct provider credentialing, re-credentialing, contracting, maintenance, and payment activities timely for Wellmark networks. Provide written communication directly to providers through notification letters.

b. Organize information for Credentialing Committee action (e.g. Clear Pass, Needs Review) based on NCQA guidelines.

c. Assist with the monthly mailing of re-credentialing applications and perform follow up based on documented work instructions to ensure completion of process within timeframes assigned.

d. As assigned, manage the delegation relationship and contracting and credentialing activities with key provider organizations that perform credentialing and re-credentialing functions on behalf of Wellmark.

e. Maintain provider databases accurately and timely in order to support claims processing, provider data reporting, data transfers to external vendor files and directory publication for all Wellmark networks. Perform provider pricing updates accurately and timely as identified.

f. Maintain multiple internal databases for provider number matching to meet HIPAA mandates and for crossover claims from other payers to ensure Wellmark processes claims accurately and timely for providers and members.

g. Act as a subject matter expert in support of Network Administration Operations responding to provider inquires related to network participation, status of enrollment process, and overall provider record information.

h. Process provider contract terminations timely and accurately to ensure that our members receive the appropriate benefits. Issue formal termination letter to provider along with notification to internal and external parties, as appropriate.

i. Participate in audits initiated internally and by external vendors such as BCBS Association, as well as self-audits, to document compliance with department policies as part of daily operations.

j. Research data base maintenance reports designed to identify errors that will impact provider data sent to outside vendors.. Correct data, modify data policies and process steps to eliminate errors, if needed.

k. Meet both quality assurance and production metrics established by Network Administration leadership.

l. Collaborate and work as a team to coordinate and integrate responses and actions with other network management team members as well as across the department and with other internal partners such as claims or customer/provider service.

m. Demonstrate understanding and accurate interpretation to support compliance with regulatory standards e.g. NCQA and HIPAA. Professionally handle confidential and protected health information.

n. Other duties as assigned.

An Equal Opportunity Employer

The policy of Wellmark Blue Cross Blue Shield is to recruit, hire, train and promote individuals in all job classifications without regard to race, color, religion, sex, national origin, age, veteran status, disability, sexual orientation, gender identity or any other characteristic protected by law.

Applicants requiring a reasonable accommodation due to a disability at any stage of the employment application process should contact us at careers@wellmark.com

Please inform us if you meet the definition of a "Covered DoD official".