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Medical Assistance Operations Analyst- UPMC Health Plan

  • Job ID: 790747204
  • Status: Full-Time
  • Regular/Temporary: Regular
  • Hours:
  • Shift: Day Job
  • Facility: UPMC Health Plan
  • Department: 68740 HPLAN Medicaid Programs
  • Location: 600 Grant St, Pittsburgh PA 15219
  • Union Position: No
  • Salary Range: $25.81 to $44.67 / hour

Description

UPMC Health plan is seeking a Medical Assistance Operations Anayst! The MA Operations Analyst will support the Medical Assistance Department's operational related activities to meet or exceed the expectations of the Department of Human Services (DHS) .The position will serve as the primary point of contact for the day-to-day management of operational issues responding to urgent and time-sensitive issues and requests.

This team is operational group within the Medicaid Department. They interface with basically every department. The role would involve working among a group of other analysts.

This role is remote during COVID and will be re-evaluated afterwards. 

Responsibilities:

  • Ensures that all correspondence received from DHS is logged, monitored and accurately communicated throughout the entire Health Plan and that all Health Plan operational activities, responses, and reporting requirements are submitted to DHS in a timely manner.
  • Maintain an effective tracking and monitoring system, i.e., utilizing the department Access database and shared mailbox, for DHS complaint resolution, daily issue tracking and both periodic and ad hoc reporting. Including, routine archiving and data back-up.
  • Maintain highly organized and very detailed on-line filing system to facilitate effective, accurate responses to internal and external requests.
  • Conduct primary and secondary research (e.g. on-line, hard copy manuals, phone calls, etc.) to prepare accurate and timely responses to internal/external and DHS requests for information including member and provider complaints or other miscellaneous topics. Monitor due dates and perform needed follow-up with task owners.
  • Aid in the preparation of research responses, periodic reports and member/provider communications for required submission of final versions that are well-coordinated and meet time-sensitive agency deadlines.
  • Prepare agendas, take minutes and arrange other logistics, i.e. room reservations, catering, etc. for operational activities between the Health Plan and DHS.
  • Prepare accurate and detailed meeting minutes (as necessary) during meetings with third-party vendors or consultants hired to perform requested functions.
  • Implement various operational elements and procedures that resulted from DHS inquiries.
  • Participate in the policy and contract review process. Maintain policies tracking spreadsheets utilizing Excel and Word. Input data in external department's policy site. Coordinate the policy submission process to DHS Core Team, and HP Policy committee.
  • Participate in improvement sessions with various management staff of internal departments and the Medical Assistance Department to continually enhance the quality and timeliness of Health Plan operational activities and responses to DHS.
  • Participate in the development, review/edit and distribution of Health Plan member and provider materials while following established protocol for seeking DHS prior approval as required. Process and follow-up all on requests for DHS approval, i.e. community events, marketing requests, annual work plans, communications, etc.
  • Create, maintain, and submit recurring and ad-hoc reports as needed.
  • Assist with the preparation of materials for use during financial and operational negotiations with DPW relating to the Health Choices Program.
  • Work with the Medical Assistance Administration, and other various Health Plan departments such as but not limited to, Finance, Community Outreach and Operations departments to carry out tactical directives that resulted from strategic product development meetings related to the Medical Assistance program.
  • Work with other department leaders to ensure service area expansions, benefit changes or other regulatory changes are well-coordinated and meet time-sensitive agency deadlines.
  • Perform special projects as periodically assigned by management.

 

Qualifications

  • Bachelor's Degree preferred
  • Minimum of 3 years of demonstrated experience/knowledge of Managed Care (Health Insurance) required
  • Experience with Medicaid managed care is preferred.
  • Excellent organizational capabilities with ability to work effectively as a team player.
  • Ability to continuously interact effectively and professionally with all levels of UPMC Health Plan and DHS staff is required as well as forge strong interpersonal relationships within DHS, other Health Plan departments, and external audiences
  • Excellent written and oral communication skills.
  • Background in areas such as: Communication, Data entry, Compliance, Administrative is preferred
  • Attention to detail is required
  • Willingness and ability to learn new operational procedures and information within short-time frames is required.
  • Ability to handle multiple priorities/projects in a fast-paced professional environment is required.
  • Excellent planning, communication, documentation organizational, analytical, and problem solving abilities required.
  • Strong computer skills with a working knowledge of project management, word-processing and database software, i.e. Access, Share Point, Excel, Word etc required.
  • Demonstrated performance in meeting deadlines required.


Licensure, Certifications, and Clearances:

UPMC is an Equal Opportunity Employer/Disability/Veteran

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   Current UPMC employees must apply in HR Direct