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Description

Penn Medicine is dedicated to our tripartite mission of providing the highest level of care to patients, conducting innovative research, and educating future leaders in the field of medicine. Working for this leading academic medical center means collaboration with top clinical, technical and business professionals across all disciplines.

Today at Penn Medicine, someone will make a breakthrough. Someone will heal a heart, deliver hopeful news, and give comfort and reassurance. Our employees shape our future each day. Are you living your life's work?

Entity: Corporate Services

Department: Medical Affairs - Admin

Hours: Remote, M-F, daylight

The Payor Enrollment Business Analyst I is accountable for continual monitoring, improvement and maintenance of the Central

Verification Organization's enrollment system and process in order to ensure the timely and accurate enrollment of the CVO's 70 + Health Plans in accordance with appropriate regulatory approvals. This position will collaborate with various levels of Office of Medical Affairs staff and departments across the health system to provide analysis and technical assistance.

Accountabilities

Primary responsibilities will include:

Act as a Liaison with the Enrollment Leadership, Enrollment Coordinators and Developers to address payor enrollment issues.

Seek resolution to enrollment system errors that are identified. Track and Trend the enrollment errors

Working directly with OMA Director, Payor Enrollment Sr. Manager and Enrollment Supervisors, in coordination and support of projects;

Interpretation of data, identification of modification requirements and recommendations;

Support and feedback regarding projects;

Monitoring of automated ECHO processes and escalating issues to support team and/or vendor;

Trending and identifying issues related to the payor enrollment processes and timeliness of monthly exports, discrepancies, aging inventory according to the health plan Delegated Credentialing Agreement (DCA).

Acts as a Subject Matter Expert (SME)to develop/create standardize reports to identify and capture enrollment errors timely.

Report Writing, Analysis & Documentation:

Preparation of Root cause analysis of provider maintainence reports and enrollment payment discrepancies.

Quarterly summary and detail reports as assigned to senior leadership.

Creates and maintains documentation and updates related to the enrollment processes;

Creates standard and ad-hoc reports in Echo through development and maintenance of filters and reports and by using raw data supplied by the Development Team, including but not limited to reports on enrollment performance.

Investigates discrepancies related to provider enrollment and supporting documentation; formulate appropriate course of action; examine for to ensure we remain within our Delegated Credentialing Agreement(DCA) compliance according to the Health Plans.

Identifies and flags time-sensitive enrollment information for reporting and escalation.

Gathers and analyzes data for potential business expansion and/or to seek and create an enrollment error free environment.

Identifies automation opportunities. Track, Trend and Document all outcomes.

Assists with creation of daily and monthly reports, dashboards and visualizations to understand business performances.

System Development & Troubleshooting:

Develops Jira (project management software) stories (end-user requirements) and assess requirements for the development of a credentialing system initiative or enhancement; Assist in the prioritization of stories with the Development Team.

Performs duties in accordance with Penn Medicine and entity values, policies, and procedures

Other duties as assigned to support the unit, department, entity, and health system organization

Minimum Requirements

Required Education and Experience

Or

Bachelor's Degree in Business Administration, Health Care, Computer Science preferred And 2+ years of Proven experience in credentialing, payor enrollment, hospital, or similar experience is required. (Master’s Degree is preferred)

Extensive knowledge of all credentialing processes, systems, and interfaces (e.g. ECHO, Enrollment Dashboard, Create Reports in ECHO, PennMAPP, etc.) is preferred.

Candidates with experience with Microsoft Excel tables and queries are prefered.

Licenses, Registrations, and Certifications

Project Management Certification is preferred.

Required Skills and Abilities

Understanding of all applicable regulatory standards, all Penn Medicine medical staff bylaws and applicable policies, and business rules.

Excellent time management and organizational skills with the ability to handle competing priorities.

Demonstrated ability to work independently and cross functionally.

Ability to effectively interact with customers to understand their needs, explain data, requirements and provide recommendations.

Demonstrated ability to maintain information in a confidential manner in accordance with all regulatory requirements, HIPAA and PHI

Self-motivated, detailed oriented, quality and precision focused.

Excellent problem solving, critical thinking and analytical skills. Demonstrate good judgement and professionalism.

discretion.

Proficient in computers and computer software including, but not limited to, database management, etc. Spreadsheet and word processing applications.

We believe that the best care for our patients starts with the best care for our employees. Our employee benefits programs help our employees get healthy and stay healthy. We offer a comprehensive compensation and benefits program that includes one of the finest prepaid tuition assistance programs in the region. Penn Medicine employees are actively engaged and committed to our mission. Together we will continue to make medical advances that help people live longer, healthier lives.

Live Your Life's Work

We are an Equal Opportunity employer. Candidates are considered for employment without regard to race, ethnicity, color, sex, sexual orientation, gender identity, religion, national origin, ancestry, age, disability, marital status, familial status, genetic information, domestic or sexual violence victim status, citizenship status, military status, status as a protected veteran or any other status protected by applicable law.

REQNUMBER: 274924