Responsible to produce all UM reporting requirements for HN1 and its Health Plan clients. Reviews and analyzes all UM reports and informs Directors, Sr. Directors and CMO of outliers. Monitors database for data integrity. Responsible for tracking daily, weekly, monthly, and annual reporting requirements. Interacts with clients and internal staff to ensure that reports are submitted timely. Responsible for ensuring report submissions are documented, archived, and available for client and/or internal audits. Maintains log of all reporting requirements, tracks and communicates deadlines to internal staff members and management team.
Produces monthly and quarterly Power Point presentations with data interpretation to Health Plan clients and HN1 entities. Maintains and updates UM policies and procedures, at least annually, and more frequent if required. Responsible for completion and submission of UM Health Plan Audit requests. Assists with documentation required to obtain UM state licenses
Essential Functions & Responsibilities
- Aware of all Service Level Agreements required by each Health Plan, State and Federal agency
- Responsible for reviewing and approving all UM reports due to the health plans. This includes:
- Data validation of all UM reports
- Ticket creation related to reporting errors
- Tracking those tickets and resolutions
- Keeping management in the loop when there are critical problems and potential for missing deadlines
- High level of proficiency with Microsoft Office Suite, including strong Excel skills. Prepare schedules and produce monthly/quarterly reports.
- Participate in the development of the internal/client reports inventory
- Strong documentation skills; assist with Business Requirement Document development.
- Help investigate internal & external queries with regards to client requirements.
- Ability to build strong relationships with clients and colleagues.
- Able to work on multiple projects with accuracy and efficiency, while keeping to deadlines.
- Strong attention to detail and record-keeping, balanced with the ability to think strategically.
- Strong analytical, problem-solving and organizational skills.
- Performing ad-hoc reviews of reports for prevention of errors, TAT related or reporting related
- Responsible for creating the UM PowerPoint Presentations and the various UM weekly, monthly, and yearly reports that are presented to various Health Plans during JOC meetings as well as Quarterly internal meetings. Ensuring the data aligns with what is reported on the UM Dashboard and reports monthly and quarterly to the Health Plans.
- Ensures integrity of data entered into company systems and/or databases
- Prepares Health Plan annual audit requests, and any ad hoc audit requests, at the direction of management
- Gathers all policies related to the request
- Prepares cases for Health Plan review
- Analyzes and reports to management any areas that put the department at risk
- Maintain UM policy and procedures. Reviews each policy annually. Ensures each policy is up-to-date with the most recent local, state, and federal requirements. Updates the policies whenever there are CMS, other federal, state and local agency changes, or direction given by a Health Plan.
- Assist with obtaining company UM State Licenses
- Review requirements
- Fills out UM application
- Provides UM documents required
- Tracks status of the application
- Tracks other states that require UM License.
- Ability to safely and successfully perform essential job functions consistent with the ADA, FMLA, and other federal, state, and local standards, including meeting qualitative and/or quantitative productivity standards.
- Ability to maintain reasonably regular, punctual attendance consistent with the ADA, FMLA, other federal, state, and local standards, and company attendance policies and procedures.
- Compliance with all personnel policies and procedures.
- Perform additional duties and related essential duties as assigned.