Renown Health Health Plan Performance Analyst in Reno, Nevada
Health Plan Performance Analyst
Requisition id: 140319
Department: 500607 Planning and Performance
Facility: Hometown Health Management
Location: Reno, NVPosition Purpose: The purpose of the Health Plan Performance Analyst position is to support Hometown Health with the evaluation of the adequacy and effectiveness of internal processes, information systems, controls, risk management, and governance for Medicare and Commercial benefit plans. This evaluation includes the identification and escalation of issues and risks along with the development and tracking of action plans to address needed changes and improvements. This position also provides support for Centers for Medicare & Medicaid Services (CMS) and state non-financial compliance activities through research, investigation, and measurement of policy and procedure effectiveness. Nature and Scope: Under the direction of the Manager of Performance, this position is responsible for undertaking projects and work efforts to analytically evaluate Hometown Health and vendor processes, systems, and controls to identify and assess performance compared to set targets and industry baselines. As part of this effort, the incumbent is responsible for defining and driving needed action plans to improve performance where necessary. Additionally this position will perform operational and compliance audits and must be objective and independent of the activity being reviewed. It is authorized to have free and unrestricted access to organization functions, records, property, and personnel.
KNOWLEDGE, SKILLS & ABILITIES :
General knowledge of Health Insurance, Claims Data, Managed Care, Benefit Design, Nevada Revised Statutes (NRS), Nevada Administrative Codes (NAC), Medicare Advantage (MA) plans, Medicare Advantage Prescription Drug (MA-PD) plans, and Federal Regulations.
The position requires the ability to recognize and research the existence of current or potential problems and perform related audits in the following areas: standards, procedures, and techniques; clinical principles and techniques; management principles and deviations from good business practices; and fundamentals of business..
The position requires ongoing, clear communication in with staff and leaders in all departments regarding project objectives, evaluations, conclusions, and recommendations, including leading non-subordinates to the common goal of improved performance measures. Effective and collaborative working relationships with internal and external stakeholders must be maintained. The position may be responsible for providing input to leadership regarding overall staff performance relative to assigned tasks and processes.
The incumbent must be able to prioritize, initiate and manage complex projects using specific, goal oriented action and project plans that are accurate, timely, and meaningful. The plans require defining needed process, technology, or people changes, guiding and monitoring cross-functional teams, and outreach to vendors or providers when necessary.
Ability to design, develop, and maintain documents, logs, and spreadsheets, including appropriately securing and handling any related confidential files and information.
Strict adherence of rules and regulations for confidentiality and compliance.
Ability to review and understand insurance benefits for all product lines.
Demonstrate strong attention to detail and organizational skills.
Excellent oral and written communications skills.
Ability to work independently or as part of a self-directed work team. Minimal detailed instruction will be given.
Philosophy consistent with the corporate culture, Fundamentals and Standards of Conduct of Renown Health. It is common to encounter potential hazards in the healthcare environment. Some of these hazards could include, but are not limited to: Radiation, Toxic Chemicals, Biological Hazards, Heat, Noise, Dust and Stress. Renown Health has a Safety Management Program in place addressing these issues.
This position does not provide patient care. The foregoing description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills and efforts or work conditions associated with the job. It is intended to be an accurate reflection of the general nature and level of the job. Minimum Qualifications: Requirements – Required and/or Preferred Education: Must have working-level knowledge of the English language, including reading, writing and speaking English. Four-year degree from an accredited college preferred. Bachelor’s degree in Business, Healthcare, Management Information Systems, or Computer Science strongly preferred, but not required. Healthcare Administration or other Healthcare field will receive preference. Experience: Minimum two years experience in compliance within the health insurance industry or health care, preferred. Experience with Medicare Advantage plans or Medicare Managed Care preferred. License(s): None. Certification(s): None. Computer / Typing: Must be proficient with Microsoft Office Suite, including Outlook, PowerPoint, Excel and Word and have the ability to use the computer to complete online learning requirements for job-specific competencies, access online forms and policies, complete online benefits enrollment, etc. Typing 35 WPM.