LTSS Provider Network Operations Analyst II- MUST RESIDE IN THE STATE OF OHIO!

Provider Network Operations Analyst II

The Provider Network Operations Analyst II executes small to medium scale project plans, business and data analysis, and provides specialized support of the LTSS & HCBS provider network and EVV compliance initiatives. Essential functions include analyzing data, workloads, and processes to enhance operations efficiencies in support of LTSS & HCBS providers. The role involves identifying trends and solutions to operational support and ensuring provider adherence to regulatory and contractual requirements. It also includes performing quality assurance reviews to ensure that provider information is loaded correctly, and contracting terms are accurately operationalized. The analyst assists with research and resolution of provider inquiries and provides a professional and comprehensive response to providers and other stakeholders as required. Additionally, the role involves improving Electronic Visit Verification compliance rates for the provider network, managing virtual initial onboarding and ongoing education, and optimizing service delivery and provider experience. The analyst also assists with network adequacy requirements through analysis and service delivery, resulting in provider retention. They are responsible for understanding regulation changes and monitoring the LTSS and HCBS provider network for compliance. The role partners with leadership within the business area to prioritize opportunities to achieve department and organizational goals. Support LTSS updates via network notifications, virtual townhalls, and direct interactions. Recognize and proactively identify operational dependencies and process improvements. Develop and maintain dashboard reporting for leadership. Produce detailed reports and business decision documents. Develop and maintain an in-depth knowledge of the company's business and regulatory environments. Perform any other job-related instructions as requested.

Education and Experience : Bachelor of Science / Arts degree or equivalent years of relevant work experience is required. Minimum of three (2) years of business management or health care operations experience in insurance, managed care, or related industry is required. Minimum of two (2) years Provider Relations experience is required. Advanced knowledge of Medicaid, Medicare, MyCare, LTSS, HCBS, and Ohio Home Care Waiver is required. Minimum of two (2) years of experience in leading business initiatives to drive systemic change is preferred.

Competencies, Knowledge and Skills : Proficient in Microsoft Office Suite to include Word, Excel, and PowerPoint. Proficient in data analysis. Effective identification of business problems, assessment of proposed solutions, and understanding of the needs of business partners. Proven experience with project management tools and resolution of open issues. Ability to execute small to medium scope project plans including business requirements gathering, definition / prioritization, project scope definition, training, and documentation. Comprehensive knowledge of project methodology, scheduling, and forecasting skills. Excellent written and verbal communication and interaction skills. Knowledge of regulatory reporting and compliance requirements. Effective problem-solving skills with attention to detail. Ability to develop, prioritize, and accomplish goals.

Licensure and Certification : Employment in this position is conditional pending successful clearance of a driver's license record check. If the driver's license record results are unacceptable, the offer will be withdrawn or, if you have started employment in this position, your employment in this position will be terminated. To help protect our employees, members, and the communities we serve from acquiring communicable diseases, Influenza vaccination is a requirement of this position. CareSource requires annual proof of Influenza vaccination for designated positions during Influenza season (October).