Analyst – Medicaid Network Operations

This is a fully remote position, open to applicants in Illinois.

📋 Description

• Conduct comprehensive reviews of all incoming contractual documents to verify their completeness and accuracy; collaborate with contracting personnel to acquire any missing or incomplete documents as necessary.

• Coordinate with the national provider data service team to efficiently add newly contracted providers to the provider record database.

• Audit updated provider records to confirm that the correct modifications have been made to the database; submit corrections when required.

• Maintain the central repository of participating provider contracts, ensuring newly executed provider agreements are added promptly.

• Oversee the contracting team email inbox; effectively respond to and triage both internal and external communications to the appropriate individuals. Ensure responses to emails are provided within established turnaround times.

• Investigate and address inquiries from providers and internal staff regarding contractual issues, such as a provider's participation status in the Aetna Better Health of Illinois provider network.

• Distribute provider welcome packets to newly contracted providers.

• Assist with internal contract auditing processes as needed.

• Compile, summarize, and report on the Health Plan’s adherence to contract submission regulations and exception requests, communicating at least on a monthly basis.

• Support various claims projects and audits, along with reviewing contracts and plan documents.

• Ensure compliance with health plan, corporate, state, and federal regulations.

• Timely escalate issues to management as necessary.

• Collaborate with members of Network Development and internal department staff to identify opportunities for process improvements.

• Execute other duties as assigned.

⛳️ Requirements

• 2-5 years of professional experience, including at least 1 year in the healthcare sector.

• Proficiency in TriZetto QNXT.

• Familiarity with medical terminology.

• Competence in using Microsoft Office Suite.

• Demonstrated ability to manage multiple workflows, prioritize tasks effectively, and meet deadlines.

• Excellent written and verbal communication skills, with the capacity to convey complex information in a clear manner.

🏝️ Benefits

• Medical, dental, and vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• Additional resources, based on eligibility.