Contract Information Management Analyst IV Must Live on the Island of Oahu

Job Summary

In addition to the responsibilities listed below, this position is also responsible for supporting contract data organization and abstraction by identifying and capturing moderately complex data, reconciling discrepancies, and identifying errors and initiating corrections for contractor and contract data to aid downstream contracting processes; reviewing provider demographic and contract configuration updates and contract rules, rates, and term updates for moderately complex contracts to ensure accurate integration in the appropriate systems of record; creating and/or updating the provider data and contract configuration spreadsheets; conducting and/or collaborating in advanced analyses of provider and contract data to develop recommendations for improvement initiatives; implementing process improvement initiatives to aid providers and business goals; and participating in collaborations with internal and external partners to develop network strategies and implement improved access to care.

This role is also responsible for contributing to provider satisfaction by leveraging in-depth knowledge of provider and contracting data to support contract managers on issues that arise from contract configuration/interpretation and/or related to referral, claims/disputes, billing, payment, reimbursement, directories, and other operational issues; ensuring requests for information, questions, and problems are identified, documented, and addressed in a timely manner; ensuring contract commitments are met by validating and/or summarizing provider and contract data in appropriate platforms and supporting the consultation of provider compliance; identifying and documenting provider activities and/or supporting the coordination with alternate stakeholders to ensure compliance with contract terms and conditions; reviewing simple-to-complex provider and contract data to ensure compliance with state and federal regulations as well as KP policies and procedures; and consulting with internal and external stakeholders as needed to ensure proper contract interpretation and operational readiness and implementing corrective actions as identified through contract performance.

Essential Responsibilities

• Promotes learning in others by proactively providing and/or developing information, resources, advice, and expertise with coworkers and members; builds relationships with cross-functional/external stakeholders and customers. Listens to, seeks, and addresses performance feedback; proactively provides actionable feedback to others and to managers. Pursues self-development; creates and executes plans to capitalize on strengths and develop weaknesses; leads by influencing others through technical explanations and examples and provides options and recommendations. Adopts new responsibilities; adapts to and learns from change, challenges, and feedback; demonstrates flexibility in approaches to work; champions change and helps others adapt to new tasks and processes. Facilitates team collaboration to support a business outcome.
• Completes work assignments autonomously and supports business-specific projects by applying expertise in subject area and business knowledge to generate creative solutions; encourages team members to adapt to and follow all procedures and policies. Collaborates cross-functionally and/or externally to achieve effective business decisions; provides recommendations and solves complex problems; escalates high-priority issues or risks, as appropriate; monitors progress and results. Supports the development of work plans to meet business priorities and deadlines; identifies resources to accomplish priorities and deadlines. Identifies, speaks up, and capitalizes on improvement opportunities across teams; uses influence to guide others and engages stakeholders to achieve appropriate solutions.
• Contributes to data abstraction by: identifying and capturing key moderately complex administrative and clinical data elements, such as patient data; reviewing medical records to identify moderately complex data required for secondary use; leading the review of regulatory requirements to ensure that changes are integrated correctly (e.g., metric changes); leading the review of information from electronic health records and uploading for use and reduction of abstraction needs; and transferring data as needed for a variety of data transfers.
• Manages overall data process and maintenance by: entering, maintaining, and reconciling data; verifying accuracy of information independently; and responding to moderately complex requests independently for data from various departments to support business processes.
• Supports or leverages data processing by: conducting somewhat advanced data uploads; coordinating with the team on the verification and organization for a variety of data; and reconciling complex discrepancies between data sources and escalating issues to a supervisor/manager and coordinating with other departments as needed.