Vendor Analyst (Healthcare / Insurance)
JOB SUMMARY: Maintains a successful working relationship between IMAS and 3rd party vendors through a full range of supplemental benefit and administrative vendor service interactions. Identify and remediate operational short-falls, respond to customer complaints and customer satisfaction surveys, research and resolve issues. Confirm service capability and educate vendors on contract expectations, processes, and paperwork. Must be able to routinely evaluate and analyze the most beneficial solution for members, operational leaders and our 3rd party vendors in a variety of circumstances. ESSENTIAL JOB FUNCTIONS: 1. Research and identify potential supplemental benefit and administrative vendors. 2. Evaluate vendor capabilities, quality, and pricing. 3. Negotiate contracts and terms with vendors. 4. Build and maintain strong vendor relationships. 5. Monitor vendor performance and address issues. 6. Obtain & audit monthly roster from the vendor. 7. Establish a monthly timeline for reoccurring roster submissions with supplemental benefit vendors. 8. Oversee and/or conduct periodic supplemental benefit vendor monitoring calls to verify member acceptance at participating locations. 9. Liaison with operational leaders of appropriate benefit or administrative area. 10. Identify areas of concern/pushback and share with vendor. 11. Maintain on-going log to record intended vendor solutions so that the information can be readily shared with leadership. 12. Provide clear and concise reporting on procurement activities 13. Provide reports to leadership, as directed. 14. Provide monthly deficiency report to Compliance Department including audit/monitoring work plans. 15. Promptly communicate to Compliance Officer and appropriate leadership any compliance-related matters. 16. Work directly with Finance/Accounting Department on vendor invoice reconciliation (monthly or as needed) 17. Oversee New Vendor Implementation Process, ensuring all departments complete deliverables and all processes are in place and operational prior to vendor start date. 18. Coordinate and moderate New Vendor Kick-Off Meetings. 19. Serve as direct plan contact for vendors as it relates to data requests, invoice reconciliation. MARGINAL JOB FUNCTIONS: 1. Takes on special projects as needed. 2. Performs other duties as assigned. BEHAVIORAL EXPECTATIONS: 1. Continuous Learning: a. Attends staff meetings as required. b. Attends appropriate training, seminars and workshops as required 2. Customer Focus: a. Maintains client/customer confidentiality and privacy in accordance with HIPPA regulations and IMAS’s Standards of Conduct. b. Fosters appropriate communication and relations with Supervisor, co-workers and other staff. 3. Quality/Process Improvement/Safety a. Reports issues of security, health and/or safety to appropriate supervisor as soon as practicable. b. Supports and demonstrates safety throughout all duties performed. c. Follows established policies and procedures and understands and complies with all regulators standards set forth by governing entities. 1. Adheres to payroll policies and properly uses the timekeeping system with minimal manual changes. 2. Maintains regular and consistent attendance. 3. Adheres to Compliance Plan and HIPAA regulations. POSITION REQUIREMENTS: EDUCATION/EXPERIENCE:
- Bachelors degree or equivalent.
- 5+ years exp. in healthcare, insurance or related industry
SKILLS/KNOWLEDGE/ABILITY:
- Analytical Skills
- Familiarity with Medical Terminology
- Intermediate Computer Skills including Microsoft Office and Virtual Conferencing
- Interacts with vendor with professionalism and courtesy.
- Willingness and ability to read, write, speak, understand English and have the communications skills necessary to provide accurate information to members and staff.
- Willingness and ability to follow written and verbal direction in English.
- Willingness and ability to maintain appropriate level of confidentiality and privacy.
- Willingness and ability to interact professionally with all customers, members, and co-workers, individually and as part of a team.
- Willingness and ability to effectively handle multiple items/tasks as required and adapt favorably to changing priorities.
- Willingness and ability to make appropriate judgments, decisions and problem solving in a timely manner and within the context of the situation at hand.
- Ability to effectively prioritize items/tasks as required.
- Willingness and ability to take initiative and be a self-starter.
- Willingness and ability to understand and comply with Federal, State, and local regulations.