GEHA is a leader in health services for federal employees and related customers, serving our chosen markets with low-cost offerings and best-in-class customer care, sustained by a nimble and efficient organization.
An Executive Order was released stating that federal contractors must require COVID-19 vaccinations for all US employees. As a company that works on federal contracts, we have a legal requirement to comply with the executive order, if it is enforced.Provides technical oversight to Health and Business staff, responds to questions, complex service issues, and workflow issues. Monitor and report to management issues that impact the integrity of the networks including, provider and member data, service issues, system audits and internal operational issues. Assists Management with special projects, implementation and execution of new programs and processes. Analyzes department production reports, turnaround time and various department data. Works cross functionally with many areas throughout GEHA to coordinate and implement multi-departmental contract processes.
Monitor reports to ensure turn-around-times and deadlines are met.
Answer questions from staff and Management involving all types of contractual issues, including but not limited to balance billing, network participation status, fee schedule issues, pricing requests, and appeals.
Research and draft responses for submission to Appeals and Compliance.
Create, regularly review, and complete needed updates for department job aids. and department job aides and completes regular review of these for needed updates.
Review Network reports for potential non-compliance of access to care requirements needed to meet OPM contractual requirements.
Identify error trends and determine training needs. Create documentation and facilitate this training as needed.
Coordinate special projects requested by management including documentation, research, and analyzing findings.
Assist staff with claim adjustment projects resulting This including determining appropriate workflow, resources needed, and coordinating with internal departments to insure minimal impact on Claims division.
Address daily reports received from networks including, but not limited to, network claim reports.
Assists all other GEHA Divisions with requests for provider network support.
Provide support with projects related to Accreditation.
Handle escalated phone calls from members and providers as needed.
Prepares reports from data files for department using enterprise accepted analytical and data sources and creates supporting documentation.
Conducts basic research and analysis on findings and shares results and insights back to supervisor.
Thorough knowledge of business needs and enterprise accepted reporting and data sources to ensure requests are satisfied.
Creation of projections based on analysis of data.
Create and make changes as needed to desk level procedures and maintain this information within the Department SharePoint Page.
Other duties as assigned.
Requirements: Education & Experience
Requires two years of college (60 credit hours), additional years of qualifying experience may be considered in lieu of education
Requires five years of data analysis/reporting focused experience that includes healthcare/insurance or similar industry experience
Requires ability to work with large sets of data
Requires critical thinking skills for extrapolation and evaluation of data for future projections
Requires effective verbal and written communication skills to respond to members, providers, network vendors, and internal contacts
Requires advanced knowledge of MS Excel and Access
Requires analytical skills to evaluate network, provider, vendor, and member data
Requires strong organizational skills
Some travel may be required
Healthcare/clinical/insurance administration experience
GEHA is an Equal Opportunity Employer. GEHA will not discriminate against employees or applicants because they have inquired about, discussed, or disclosed their compensation or the compensation of another employee or applicant. Our company's corporate headquarters is located in Lee's Summit near Douglas Rd and I-470 with a total of five locations in the Kansas City metropolitan area.