You Make Us Grow. You Make Us Sharp.

Hours:

Shift Start Time:

8 AM

Shift End Time:

5 PM

AWS Hours Requirement:

8/40 - 8 Hour Shift

Additional Shift Information:

Weekend Requirements:

No Weekends

On-Call Required:

No

Hourly Pay Range (Minimum - Midpoint - Maximum):

$46.110 - $59.500 - $66.650

The stated pay scale reflects the range that Sharp reasonably expects to pay for this position.  The actual pay rate and pay grade for this position will be dependent on a variety of factors, including an applicant’s years of experience, unique skills and abilities, education, alignment with similar internal candidates, marketplace factors, other requirements for the position, and employer business practices.

Please Note: As part of our recruitment process, you may receive communication from Dawn, our virtual recruiting assistant. Dawn helps coordinate scheduling for screening calls and interviews to ensure a smooth and timely experience. Rest assured, all candidate evaluations and hiring decisions are made by our recruitment and hiring teams.

What You Will Do
The Lead position will manage a team of business analysts and coordinators encompassing all aspects of network compliance for the Plan's provider data operations, provider data systems and applications, and regulatory reporting. The Lead will oversee provider data project initiatives at the Plan, and provide project management, quality assurance, and IT business systems expertise.

Required Qualifications

• Bachelor's Degree Business administration, computer science, information science, management information systems, or healthcare related field.
• 5 Years experience in business analysis, systems analysis/configuration, or process improvement.
• 2 Years experience with software applications for healthcare functions, such as credentialing, provider management, claims processing, call center integration, utilization management, case management, medical review, pharmacy, quality and reporting.
• 1 Year Experience in health plan accreditation and regulatory requirements, and/or regulatory filings for the DMHC, CMS and Covered CA.

Preferred Qualifications

• Master's Degree Business administration, computer science, information science, management information systems, or healthcare related field.
• Leadership experience.

Essential Functions

• Leadership
  
  Leads a team of business analysts and coordinators to develop and maintain best-in-class and compliant provider data operations, including systems, applications, and reporting.
  Provides oversight to ensure delivery of accurate and timely data reporting for regulators, accreditors, key customers, and other internal and external stakeholders.
  Presents feedback to both team members and leadership to effectively manage both individual and team performance.
  Manages client and department expectations through effective client communication resolving conflicts and department issues independently through effective decisions.
  Proposes and implements creative solutions to operational and application issues with follow-through to resolution.
  Ensures provider data integrity by leading the team through efficient operational workflows and data cleaning cycles for data collection, standardization, normalization, de-duplication, and verification.
  Creates new and optimizes business process workflows for efficient and compliant provider data operations.
  Develops and maintains department standards for management of network functions, including development and maintenance of desktop procedures, quality assurance checklists, compliance checklists, and data monitoring tools.
  Builds network dashboards in Tableau for ongoing monitoring of provider data, provider network changes, network metrics, and network KPIs across the department.
  Trains new and existing analysts in system and operational tasks in order to maximize effectiveness and utilization of systems.
  Oversees end-user support by directly supervising the service-related activities for the team.
  Proactively identifies opportunities to translate and adopt best practices from within and outside of Sharp Health Plan to advance strategic and operational goals.
  Uses strong data analysis and research methodologies to assess effectiveness of innovative improvement efforts and works to implement validation approaches.
• Regulatory Oversight
  Maintains regulatory and accreditation knowledge of Department of Managed Health Care (DMHC), Centers for Medicare and Medicaid Services (CMS), Covered CA, National Committee for Quality Assurance, and Health Insurance Portability and Accountability Act (HIPAA) requirements.
  Stays abreast of changing regulatory and customer requirements to ensure network compliance.
  Manages regulatory program for annual and ad hoc network filings for regulators and key customers.
  Produce business requirements and oversight of the production of network data forms and automated templates for regulatory filings and regulatory comment responses (TAR, Significant Network Change, Alternate Access, Medicare HPMS, Ad Hoc filings).
  Lead and oversee enhancements and upgrades to systems and provider applications to accommodate new regulatory requirements.
  Develops and maintain protocols, training, and oversight to ensure delivery of timely and accurate regulatory filings, data exchanges, and reports.
  Leads team in maintaining up-to-date production plans, project plans, schedules and dashboards for regulated deliverables (filings and regulatory reporting, geoaccess and adequacy monitoring, online and print provider directories, et al).
  Oversight, monitoring and quality assurance for annual reporting to Compliance for filing deliverables, e.g., network filings for DMHC, CMS, Covered CA, alternate access standards, provider directories, and other Compliance reporting, as needed.
  Analyzes department and client needs to develop a workable training plan and executes training plan appropriately.
  Identifies and trains super users and other staff in operational and system tasks to ensure regulatory compliance and maximize effectiveness and utilization of applicable systems.
  Ensures team members consistently provide audit support for DMHC, CMS and NCQA through creation, maintenance and appropriate storage of regulatory project, business rule and business process documentation in a timely, clear, and accurate manner.
• Project Management/Change Management
  Creates and maintains a matrix of all assigned projects using appropriate prioritization, timing, and creativity, such that projects are completed on time and within resource constraints.
  Oversight of communication plans, strategies and documents to keep clients informed with major initiatives or system related issues.
  Communicates in a timely fashion both to the requestor and management when project schedules may not be met.
  Provides executable alternative solutions to work around resource constraints.
  Develops comprehensive project plan and oversees individual project plans based on accurate project scope, project risk, detailed business requirements, resource allocation and scheduling requirements.
  Oversees risk identification and management plans.
  Provides oversight of team reporting for all assigned projects.
  Ensures close collaboration with internal and external technical, information systems, Compliance, and outside vendors.
  Develops department standards for management of changes and documentation requirements.
  Creates department standards for service level agreements (SLAs) to clients on submitted requests.
  Provides oversight for department change management requests and assigns resources as needed.
  Evaluates and oversees department documentation for system recovery.
  Reviews and approves changes to production environments as part of system implementations for various systems, including but not limited to, Epic, MD-Staff, Health Trio online provider directory, Tableau, Looker, SSRS, SQL/Snowflake environments, CMS's Medicare Plan Finder, Symphony (statewide DMHC attestation portal, and Sitefinity (web content management system).
• Technical Leadership
  Implements new applications and upgrades existing applications, as needed, i.e., Epic, MD-Staff, Symphony, Quest Analytics, and RightFax.
  Provides leadership with the necessary information to review current and new technologies for incorporation with existing technologies within the department.
  Acts as in-house consultant to internal and external IT application teams in the evaluation of new technologies and/or data feeds.
  Represents the Network team in launching plan- and system-wide provider applications, system enhancements and upgrades.
  Represents the department on strategic initiatives to ensure that a thorough evaluation is performed on impacts to existing applications.
  Works with IT personnel, vendors and clients in reviewing requests for appropriateness within the Sharp computing environment.
  Establishes protocols for interoperability and quality assurance for provider data systems.
  Oversees risk identification and management plans.
  Analyzes department and client needs to develop a workable training plan for systems and applications used by Health Services teams and executes training plan appropriately.
  Oversees issue resolution to ensure that problems are resolved in a timely manner and the resolution is fully documented and meets customer and IT accepted frameworks.
• Other Duties
  Participates in special projects and other duties as assigned. These may include, but are not limited to, committees, workgroups, proposals, audits and support to other departments.

Knowledge, Skills, and Abilities

• Strong working knowledge of health plan operations and business workflows.
• Must have in-depth knowledge of systems analysis, design and support of applications in a large computing environment comparable to Sharp Health Plan and Sharp HealthCare.
• Ability to oversee the design, development, and implementation of software solutions, systems, or products that meet end-user needs; excellent analysis, problem-solving, and troubleshooting skills; and the ability to manage various user requests from internal and external stakeholders.
• Ability to communicate concepts and solutions in both technical and user-friendly language. Strong ability to translate technical requirements into business language and business requirements.
• Must have excellent team management skills, with proven ability to train, coach and motivate.
• Must have strong knowledge of health plan regulatory requirements, including federal and state regulations (HIPAA, DMHC, CMS, Covered CA) and NCQA accreditation requirements.
• Must have excellent project management skills, with proven expertise in leading and overseeing project teams.
• Excellent written and oral communication skills. Excellent listening and interpersonal skills. Ability to conduct research into systems issues and products as required.
• Highly self-motivated and directed.

Sharp HealthCare is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability or any other protected class

Bachelor's Degree; Master's Degree