Sam Holmes Email & Phone Number

Minneapolis, Mn, Us

Minneapolis, Minnesota, United States

Responsible to oversee internal encounters processes on a weekly, monthly and quarterly basis per a defined and regimented schedule. Reconcile between systems and data sources to ensure accuracy and completion of encounter submissions. Subject matter expert on encounters including datasets for submissions, reporting and remediation. Lead the strengthening of cross-departmental encounter partnerships as a member of all encounter project work teams. Create, perform and test encounters datasets and processes. Proactively identify and adapt to new regulatory changes that impact encounters processes.

Greater Minneapolis-St. Paul Area

This position is responsible to manage CCO department collaboration tools, processes and related reporting in alignment with department plans, goals and objectives. Act as department single point of contact for collaboration applications including, but not limited to SharePoint and ServiceNow. Act as knowledge manager, ensuring the appropriate collection, organization and archival of departmental data, reports, artifacts and correspondence. Collect and analyze data and report findings and recommendations. Plan, document requirements, and design and document business processes; make recommendations for change in order to improve member/provider experience and/or employee engagement and enhance department efficiency. Manage process and tool enhancements throughout the project life cycle including but not limited to defining requirements, authoring various project-related documents, managing communication and relationships, and assisting with project validation through test planning and execution. Work alongside business and technical teams to increase collaboration and optimize productivity and communication. Ensure requirements and solutions conform to departmental, corporate, industry and government standards as specified.

Minneapolis

This position is responsible to ensure technology efforts that support organizational and departmental strategic plans, regulatory directives, operational initiatives and health care reforms meet deadlines and deliver agreed upon functionality. Direct the actions of the Reporting & Quality Assurance (RQA) Team to ensure new or revised benefit and pricing configuration, provider enrollment data and processed claims meets or exceeds quality standards as established through business requirements or company policies, by developing and utilizing comprehensive test scenarios, auditing, and quality assurance methodologies and tools. Provide oversight to ensure updates to pricing and benefits configuration are accurately migrated to the appropriate environments. Manage and monitor reporting, auditing and quality assurance tools. Confirm changes to CCO environments are documented and multiple environments remain in sync with environmental refreshes, software versioning and data migrations. Develop, implement and maintain reporting infrastructure in the CCO department driving towards continual improvement and transparency to departmental activities.

Minneapolis

Responsible for managing UCare’s provider network data and reporting requirements as identified for both internal and external stakeholders. Supports efforts to evolve an efficient provider data infrastructure (e.g. business rules, processes, technology, etc.) required to respond to regulatory requirements and guide strategic decision-making. Develop and manage a team of provider data analysts that support creation of required provider materials (e.g., Primary Care Network Listings, health insurance exchange provider/network filings, Health Service Delivery tables, and other provider directories).

Greater Minneapolis-St. Paul Area

This position is responsible to create Provider Network reports for various regulators (DHS, CMS, and MDH). Create PCNLs (Primary Care Network Listing), Provider Directories and policies; conduct audits of provider demographic information. Collaborate with Government Relations on regulatory audits and RFPs related to provider networks, access & availability to ensure contractual requirements are met.

Greater Minneapolis-St. Paul Area

Responsible for all aspects of the credentialing and recredentialing processes per NCQA, CMS and MDH Standards for all contracted providers. The application process includes maintenance of the online application site and forms repository and intake, review and appropriate routing of all credentialing documents. This position liaises with both internal and external agencies involved in the credentialing process.

Greater Minneapolis-St. Paul Area

Receives and processes review requests or admission notifications from physicians, vendors and facilities. Provides live telephonic access for providers and internal customers. Performs data entry in support of the review activities of each business unit in the department.

Greater Minneapolis-St. Paul Area

Perform a variety of support functions for the Claims Department including: sort and count incoming mail; scan documents and various other UCare correspondence for a variety of departments into the imaging system including Enrollment applications and claims.. File claims; retrieve claims; enter claims, correspondence, Enrollment applications, documents. Mail EOBs, EOPs and DTR explanation letters.