The Provider Data Administrator assists with the processing of in-load provider data files, rosters, and the day-to-day management of provider data operations for the Health Plan through support of building and maintaining Access databases or SQL processes. The Provider Data Administrator interfaces with Health Plan Services' provider network, Third Party Administrator (TPA), and all business units including operations, clinical services, provider relations, and finance to ensure operational quality processes are implemented. Develops a system application for Health Plan Services to meet business requirements and compliance with government program contracts such as Medicaid and Medicare.
This position is exempt from Career Service under the CCH Personnel Rules.
Facilitates the day-to-day provider data operational functions to ensure all service levels are met, quality of data is accurate, and systems are efficient for increased performance and outcomes.
Manages all incoming provider data files including provider rosters.
Maintains provider data and conducts routine audits to ensure data integrity.
Streamlines provider data collection and analysis procedures to ensure timely data upload.
Assists with developing policies and procedures and end-to-end processes to ensure compliance and adherence to health plan reporting and regulatory requirements related to provider data management.
Builds advanced SQL queries to extract datasets from a clinical data warehouse to support research and quality improvement activities.
Plans and conducts structured testing of database designs to confirm functionality and performance. Automates the maintenance of data with storage procedures, scripts, Data Transaction Services, and others as needed.
Develops, implements, and maintains complex data models and logical database designs.
Performs other duties as necessary.
R eports to the Director of Provider Data Management
Bachelor's degree from an accredited college or university (Must provide official transcripts at time of interview)
Two (2) years of experience in Medicaid and Medicare Managed Care Organization is required
One (1) year of experience working with provider data is required
Prior experience in data analytics including SQL is required
Proficient in Microsoft Office Suite including Excel (V-Lookup and Pivot Tables), Access (must be able to build tables and queries), Visio and SharePoint is required
Masters' degree from an accredited college or university is preferred
Three (3) years of work experience in a Managed Care Organization in Illinois is preferred
Knowledge, Skills, Abilities and Other Characteristics
Strong knowledge of regulatory requirements concerning Medicare and Medicaid.
Knowledge of managed care practices, provider network management, and claims.
Excellent verbal and written communication skills necessary to communicate with all levels of staff and a patient population composed of diverse cultures and age groups.
Excellent analytical skills including ability to identify unusual variation in medical costs and to access impact of change.
Strong demonstrated leadership skills to implement change and drive business results.
Strong people management skills and facilitative skills.
Ability to influence others in a desired direction towards the achievement of profitable and rewarding objectives.
Ability to maintain a professional demeanor and composure when challenged.
Ability to prioritize, plan and organize projects and tasks.
When applying for employment with the Cook County Health & Hospitals System, preference is given to honorably discharged Veterans who have served in the Armed Forces of the United States for not less than 6 months of continuous service.
To take advantage of this preference a Veteran must :
Meet the minimum qualifications for the position.
Identify self as a Veteran on the employment application by answering yes to the question by answering yes to the question, "Are you a Military Veteran?"
Attach a copy of their DD 214, DD 215 or NGB 22 (Notice of Separation at time of application filing. Please note: If you have multiple DD214s, 215s, or NGB 22S, Please submit the one with the latest date. Coast Guard must submit a certified copy of the military separation from either the Department of Transportation (Before 9/11) or the Department of Homeland Security (After 9/11).
Discharge papers must list and Honorable Discharge Status. Discharge papers not listing an Honorable Discharge Status are not acceptable
A copy of a valid State ID Card or Driver's License which identifies the holder of the ID as a Veteran, may also be attached to the application at time of filing.
If items are not attached, you will not be eligible for Veteran Preference
VETERANS MUST PROVIDE ORIGINAL APPLICABLE DISCHARGE PAPERS OR APPLICABLE STATE ID CARD OR DRIVER'S LICENSE AT TIME OF INTERVIEW.
Medical, Dental, and Vision Coverage
Basic Term Life Insurance
Deferred Compensation Program
Paid Holidays, Vacation, and Sick Time
You may also qualify for the Public Service Loan Forgiveness Program (PSLF)
Degrees awarded outside of the United States with the exception of those awarded in one of the United States' territories and Canada must be credentialed by an approved U.S. credential evaluation service belonging to the National Association of Credential Evaluation Services (NACES) or the Association of International Credential Evaluators (AICE). Original credentialing documents must be presented at time of interview.
*Please note all offers of Employment are contingent upon the following conditions: satisfactory professional & employment references, healthcare and criminal background checks, appropriate licensure/certifications and the successful completion of a physical and pre-employment drug screen.
*CCHHS is strictly prohibited from conditioning, basing or knowingly prejudicing or affecting any term or aspect of County employment or hiring upon or because of any political reason or factor.
COOK COUNTY GOVERNMENT IS AN EQUAL OPPORTUNITY EMPLOYER
ABOUT COOK COUNTY HEALTH (CCH)
The Cook County Health’s mission is to deliver integrated health services with dignity and respect regardless of a patient’s ability to pay; foster partnerships with other health providers and communities to enhance the health of the public; and advocate for policies that promote the physical, mental and social wellbeing of the people of Cook County.
CCH is comprised of two hospitals, John H. Stroger, Jr. Hospital and Provident Hospital, a robust network of more than a dozen community health centers, the Ruth M. Rothstein CORE Center, the Community Triage Center, the Cook County Department of Public Health, Cermak Health Services, which provides health care to individuals at the Cook County Jail and the Juvenile Temporary Detention Center, and CountyCare, a Medicaid managed care health plan.
The system cares for more than 300,000 patients each year and its physicians are experts in their fields, committed to providing their patients with comprehensive, compassionate and cutting-edge care. Today, CCH is transforming the provision of health care in Cook County by promoting community-based primary and preventive care, growing an innovative, ...collaborative health plan and enhancing the patient experience.
COOK COUNTY HEALTH IS AN EQUAL OPPORTUNITY EMPLOYER