Analyze data, workloads, and processes to enhance operations efficiencies in support of LTSS & HCBS providers
Identify trends and solutions to operational support and ensure provider adherence to regulatory and contractual requirements
Perform quality assurance reviews to ensure that provider information is loaded correctly, and contracting terms are accurately operationalized
Improve Electronic Visit Verification compliance rates for provider network
Manage online communications and optimize service delivery and provider 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
Proficient in Microsoft Office Suite to include Word, Excel and PowerPoint
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

Influenza vaccination is a requirement of this position
CareSource provides reasonable accommodations to qualified individuals with disabilities
Flexible hours, including possible evenings and/or weekends as needed to serve the needs of our members

LTSS Provider Network Operations Analyst II – Provider Relations, Managed Care Experience

Key skills