Contract Information Management Analyst V

Job Summary

In addition to the responsibilities listed below, this position is also responsible for driving contract data organization and abstraction by identifying and capturing key complex data, reconciling challenging discrepancies, and leading the audit process for corrections of contractor and contract data to aid downstream contracting processes; leading the review of provider demographic and contract configuration updates and contract rules, rates, and term updates for complex contracts to ensure accurate integration in the appropriate systems of record; mentoring others to create and/or update the provider and contract configuration spreadsheets; conducting advanced analyses of provider and contract data to develop recommendations for improvement initiatives; and guiding the implementation of process improvement initiatives to aid providers and business goals; and collaborating 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 advanced 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; leveraging innovative processes to ensure provider requests for information, questions, and problems are identified, documented, and addressed in a timely manner; validating and/or conducting advanced analyses on provider and contract data to identify trends and support provider compliance; documenting and reporting provider activities and/or coordinating with alternate stakeholders to ensure compliance with contract terms and conditions; reviewing complex provider and contract data to ensure compliance with state and federal regulations as well as KP policies and procedures; and leading the collaboration with all stakeholders as needed to ensure proper contract interpretation and operational readiness and guiding corrective actions as identified through contract performance.

Essential Responsibilities

• Promotes learning in others by communicating information and providing advice to drive projects forward; builds relationships with cross-functional stakeholders. Listens, responds to, seeks, and addresses performance feedback; provides actionable feedback to others, including upward feedback to leadership and mentors junior team members. Practices self-leadership; creates and executes plans to capitalize on strengths and improve opportunity areas; influences team members within assigned team or unit. Adapts to competing demands and new responsibilities; adapts to and learns from change, challenges, and feedback. Models team collaboration within and across teams.
• Conducts or oversees business-specific projects by applying deep expertise in subject area; promotes adherence to all procedures and policies. Partners internally and externally to make effective business decisions; determines and carries out processes and methodologies; solves complex problems; escalates high-priority issues or risks, as appropriate; monitors progress and results. Develops work plans to meet business priorities and deadlines; coordinates and delegates resources to accomplish organizational goals. Recognizes and capitalizes on improvement opportunities; evaluates recommendations made; influences the completion of project tasks by others.
• Contributes to data abstraction by: identifying and capturing key standard to complex administrative and clinical data elements, such as patient data; reviewing medical records to identify standard to complex the data required for secondary use; leading the review of standard and complex requirements to ensure that changes are integrated correctly (e.g., metric changes); leading the review of information from a variety of diverse electronic health records and uploading for use and reduction of abstraction needs; and transferring data as needed for challenging data transfers.
• Manages overall data process and maintenance by: leading processes for entering, maintaining, and reconciling data; leading the review and verification of information to ensure accuracy; and responding to, clarifying, and directing team to respond to standard to complex requests for data from various departments to support business processes.
• Supports or leverages data processing by: conducting challenging and advanced data uploads, such as for messy data; ensuring the verification, organization, and maintaining of data records for a variety of data; and leading the reconciliation of complex discrepancies between data sources and escalating issues to a supervisor/manager and coordinating with other departments across the company as needed.
• Ensures completion of corresponding data reports by: developing or using reporting data and metrics for internal and expert reports, and providing recommendations for improvements; and resolving complex reporting issues as needed.