Title: Provider Portal Analyst

Location: Fountain Valley / Predominantly Remote

Department: Provider Network Operations

Status: Full Time

Shift: Day

Pay Range*: $32.19/hr - $46.68/hr

MemorialCare is a nonprofit integrated health system that includes four leading hospitals, award-winning medical groups – consisting of over 200 sites of care, and more than 2,000 physicians throughout Orange and Los Angeles Counties. We are committed to increasing access to patient-centric, affordable, and high-quality healthcare; your personal contributions are integral to MemorialCare's recognition as a market leader and innovator in value-based and other care models.

Across our family of medical centers, we support each one of our bright, talented employees in reaching the highest levels of professional development, contribution, collaboration, and accountability. Whatever your role and whatever expertise you bring, we are dedicated to helping you achieve your full potential in an environment of respect, innovation, and teamwork.

Position Summary

The Provider Portal Analyst is responsible for ongoing maintenance of system records related to providers, vendors and place of service, which includes submission of updates, operational testing, integration with operational workflows. This includes monitoring the downstream impacts for migration testing, cross-interfacing and provider portal validity. The Provider Portal Analyst cross collaborates with Contracting, Utilization Management, AP, Claims and Information Services teams on workflow standardization, process design and rollout of system development through application of LEAN principles.

Essential Functions and Responsibilities of the Job

• Maintains strong understanding of Epic modules with emphasis on Tapestry and EpicCare Link to research issues reported that are related to Network Management and has a working knowledge of Managed Care, Medicare and Commercial insurance, as well as, their impact on reimbursement.

• Works with Management and Leadership teams to operationalize and communicate network decisions including but not limited to provider demographic updates, provider leveling, preference list, administration and vendor billing information.

• In accordance with Coding Compliance guidelines, conducts provider claim audits and provides ongoing education to physicians to ensure compliance and appropriate reimbursement.

• Interacts with cross functional departments, such as Medical Management, Contracting, AP Claims, Finance, Information Services and Business Intelligence, to resolve provider network issues and identify opportunities to develop best practices.

• Must be a self-directed, process and goal-oriented team player who has strong planning and organization skills to accommodate multiple or changing priorities and who is flexible and willing to work above normal workload at key times in our cycles.

• Takes personal responsibility for job performance while adhering to departmental and organizational policies and procedures.

• Ability to independently plan, organize, and prioritize work to meet changing deadlines.

• Must have excellent listening skills, as well as, excellent verbal and written skills to clearly understand requirements and expectations.

• Participate in developing, implementing, and reviewing department initiatives including workflow design and critique, policies and procedures, and physician improvement programs.

• Meet or exceed productivity and quality standards as assigned by management.

• Work as a team player and communicate in a positive manner with co-workers, managers, providers, and other contacts.

• Maintain patient confidentiality at all times.

• Maintain a safe and orderly work area.

• Ability to follow company policies, procedures, and directives.

*Placement in the pay range is based on multiple factors including, but not limited to, relevant years of experience and qualifications. In addition to base pay, there may be additional compensation available for this role, including but not limited to, shift differentials, extra shift incentives, and bonus opportunities. Health and wellness is our passion at MemorialCare—that includes taking good care of employees and their dependents. We offer high quality health insurance plan options, so you can select the best choice for your family. And there’s more...Check out our MemorialCare Benefits for more information about our Benefits and Rewards.

Minimum Requirements

Qualifications/Work Experience:

• Minimum of seven years healthcare experience working in a managed care or an information system setting is required.

• Epic or equivalent Managed Care electronic medical record system and provider portal applications knowledge preferred.

• Experience with various healthcare industry regulatory agencies and requirements including but not limited to CMS, NCQA, DMHC, ICE, DHCS, preferred.

• Proficiency in Microsoft Office applications including Word, Power Point, Excel, and Outlook is a must.

• Experience with Microsoft Access is also preferred.

Education/Licensure/Certification:

• Bachelor’s degree or commensurate experience required.