Network Integrity Program Coordinator

Network Integrity Program Coordinator

We Are Seeking Qualified Candidates to Join Our Team!

AllCare Health offers competitive wages, an excellent benefits package including affordable healthcare, 401k retirement, wellness programs, and flexible schedule options.

Summary of the Position

The Network Integrity Program Coordinator helps to ensure provider network adequacy and compliance with regulatory requirements from the Oregon Health Authority (OHA), Centers for Medicare & Medicaid Services (CMS), and other relevant agencies.

This role is responsible for the implementation of initiatives related to provider network access standards, monitoring network reports and dashboards, and assisting with regulatory audits. Collaborating with internal teams and regulatory agencies, the Program Coordinator works to enhance network adequacy, regulatory compliance and DSN performance.

Essential Duties

1. Regulatory Compliance and Audits: Ensure compliance with regulatory agencies through assisting with audits and reporting processes.
2. Provider Network Access: Implement initiatives to maintain an adequate provider network and address gaps.
3. Data Analysis and Reporting: Leverage analytics to evaluate and improve network performance and data integrity.
4. Data Integrity: Drive provider data integrity initiatives, collaborating with IT and data management teams to maintain accurate directories and system updates.

Job Duties

• Assist with provider network adequacy audits conducted by OHA, CMS, and other regulatory bodies, ensuring compliance with applicable standards.
• Oversee the preparation, submission, and response processes for provider-related audits, partnering with compliance, legal, and operational teams.
• Monitor regulatory updates and policy changes impacting network adequacy, implementing necessary adjustments.
• Deliver precise and timely reports of provider network data to regulatory agencies.
• Collaborate with contracting, credentialing, and provider relations teams to address network gaps and resolve provider issues efficiently.
• Evaluate provider access, geographic distribution, and capacity to identify deficiencies and develop corrective action plans.
• Assess DSN performance metrics, identify areas for improvement, and implement corrective actions.
• Ensure DSN compliance with all regulatory requirements, submitting necessary documentation and reports.
• Oversee provider network adequacy reports, ensuring accuracy and compliance with regulatory standards.
• Utilize data analytics to assess provider performance, access to care, and DSN effectiveness.
• Maintain punctual, regular, and predictable attendance.
• Ability to multi-task and prioritize workload
• Accept direction respectfully from leadership.
• Complete all required training, including those in Relias Learning Module System (LMS).
• Perform other duties as assigned.

On Call Responsibilities

This position does not have any on-call responsibilities.

Job Requirements

• May require the use of personal vehicle for local travel (subject to mileage reimbursement).
• May require the use of a personal cell phone (cell phone stipend applicable).

Qualifications

Ability to perform essential job duties with or without reasonable accommodation and without posing a direct threat to safety or health of employee or others. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential duties.

Education

High school diploma or general education degree (GED) required.

Experience

Two to four years of related experience and/or training in healthcare provider network management, regulatory compliance, and/or data analysis required.

Technical Skills

• Familiarity with the healthcare industry.
• Exceptional writing, editing, and proofreading skills.
• Excellent organization and time-management abilities.
• Advanced computer skills, including proficiency in Microsoft Office Suite (Outlook, Word, PowerPoint, and Excel).
• Knowledge of and compliance with HIPAA regulations.
• Knowledge of operating systems, programming languages, software programs, networks, and related technologies.
• Strong ability to identify and implement improvement activities, ensuring excellence in execution.
• Expertise in breaking projects into definable and measurable tasks, as well as tracking progress to completion.
• Knowledge of research methodologies and data analysis techniques.
• Proficiency in interpreting data to solve problems and extract new insights.
• Skill in locating and synthesizing information from various sources.
• Knowledge of customer service and service recovery best practices.
• Exceptional customer service skills, including responding appropriately and interacting positively with upset customers.
• Knowledge of project management and/or change management practices.
• Familiarity with training development and adult learning principles.
• Awareness of implicit bias, personal identity, power, and privilege in organizational and systemic contexts.
• Understanding the widespread impact of trauma and integrating trauma-informed practices into organizational policies and procedures.

Interpersonal Skills

• Demonstrate accountability, inspiring trust and confidence from others.
• Work with high initiative, energy and effectiveness in a fast-past environment.
• Effectively and professionally communicate with team members and customers.
• Collaborate with a multidisciplinary, diverse team to provide professional service.
• Prioritize and organize work according to competing timelines.
• Allocate your time so that you can complete tasks within established deadlines.
• Adapt to change, learn quickly, and work with ambiguity.
• Cope and self-manage during stressful situations.
• Maintain a high degree of professionalism and confidentiality.
• Meet timelines for goals with high level of quality.
• Take initiative and apply sound judgment in completing tasks and responsibilities.

Language Skills

Ability to read, analyze, and interpret common scientific and technical journals, financial reports, and legal documents. Ability to respond to common inquiries or complaints from customers, regulatory agencies, or members of the business community. Ability to write speeches and articles for publication that conform to prescribed style and format. Ability to effectively present information to top management, public groups, and/or boards of directors.

Mathematical Skills

Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.

Computer Skills

Job requires specialized computer skills. Must be adept at using various applications including database, spreadsheet, report writing, project management, graphics, word processing, presentation creation/editing, communicate by e-mail and use scheduling software.

Reasoning Ability

Ability to solve practical problems and work with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.

Physical Demands & Work Environment

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential duties of this job. The work environment characteristics described here are representative of those an employee

encounters while performing the essential duties of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential duties.

The employee must occasionally lift and/or move up to 10 pounds. While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel and talk or hear. The employee is occasionally required to stand; walk and reach with hands and arms. The noise level in the work environment is usually moderate.

• The employee must be able to work onsite, as needed.
• The employee must be able to work from a home office, as needed.
• The employee must be able to travel locally, as needed.

Company Overview

AllCare Health is incorporated as an Oregon Benefit Corporation and has earned the coveted Certified B Corp status since 2017. As such, AllCare Health considers its impact on community, society, and the environment in all business decisions. We have long recognized the value in social, economic, and environmental concerns of our employees, customers, and community members. (Learn more about B Corps at https://bcorporation.net/