We offer remote work opportunities (AK, AR, AZ, CA, *CO, FL, *HI, IA, ID, IL, KS, LA, MD, MN, MO, MT, NE, NV, NM, NC, ND, OK, OR, SC, SD, TX, UT, VA/DC, *WA, WI and WY ONLY.

Our Department of Defense contract requires US citizenship and a favorably adjudicated DOD background investigation for this position.

Veterans, Reservists, Guardsmen and military family members are encouraged to apply!

Job Summary

The Contract Quality Control Analyst supports the Supervisor of Provider Systems and Quality. Performs quality control activities on provider contract and data records that have been entered and processed by the Provider Data and Contracting teams. Ensures the integrity and quality of the provider contract elements, verifying the accuracy of the data and contracting information. Coordinates the internal review and audit process including assisting in monitoring production and quality goals and standards for performance. Identifies process improvements to enhance contracting data and staff quality standards.

Education and Experience

Required:

High school diploma or G.E.D. 3 years experience working with contracting or provider data Experience in interpreting policies, monitoring compliance, or developing contract management processes Working knowledge of the provider contracting process Preferred:

Bachelor's degree in Business, Health Care Administration, Data Analysis, or related field Lead role over a process Experience with Emptoris or other contracting applications Experience with Provider Data Management Systems

Key Responsibilities

Maintains all audit tools for internal and external audits. Assists in conducting Daily/Weekly/Monthly audits of contract and data staff. Monitors accuracy of the provider contract and data by conducting periodic audits. Collaborate with multiple business partners including but not limited to Contracting Administration, Corporate Compliance, Claims Administration, and Legal to create strategies for contract templates while being proactive in preventing non-compliance. Manages executed contracts and amendments across multiple channels of the healthcare business. Develops and monitors quality reports and communications using contracting and provider data management systems. Assists in producing trend reports to improve workflow efficiency and system functions to recommend possible solutions to management. Assists with resolving data quality issues by identifying, documenting, and communicating quality issues. Assists with performing root cause analysis. Provides subject matter expertise. Performs other duties as assigned. Regular and reliable attendance is required.

Competencies

Commitment to Task: Ability to conform to established policies and procedures; exhibit high motivation. Communication / People Skills: Ability to influence or persuade others under positive or negative circumstances; adapt to different styles; listen critically; collaborate. Computer Literacy: Ability to function in a multi-system Microsoft environment using Word, Outlook, TriWest Intranet, the Internet, and department software applications. Coping / Flexibility: Resiliency in adapting to a variety of situations and individuals while maintaining a sense of purpose and mature problem-solving approach is required. Empathy / Customer Service: Customer-focused behavior; helping approach, including listening skills, patience, respect, and empathy for another's position. Information Management: Ability to manage large amounts of complex information easily, communicate clearly, and draw sound conclusions. High Intensity Env ronment: Ability to function in a fast-paced environment with multiple activities occurring simultaneously while maintaining focus and control of workflow. Organizational Skills: Ability to organize people or tasks, adjust to priorities, learn systems, within time constraints and with available resources; detail-oriented. Problem Solving / Analysis: Ability to solve problems through systematic analysis of processes with sound judgment; has a realistic understanding of relevant issues. Technical Skills: Healthcare and/or Managed Care experience; working knowledge of Medicare requirements, URAC standards and State and Federal Regulations; working knowledge of the TriWest policies and procedures; current knowledge of Contract Management, Contract Negotiation and Templates, Internal Process Improvement, and medical terminology; knowledge of contracting and provider data management systems; proficient with Word, Excel, and data management systems.

Working Conditions

Working Conditions:

Availability to work any shift Works within a standard office environment, with minimal travel Department of Defense security clearance required

Annual base salary for Colorado, Hawaii and Washington State residents: $47,000 - $52,000 depending on experience