-SLA/Target Compliance for myself and my team-Process compliance for myself and my team-Talent Management, Performance Management and Career Development of my team-Customer interaction with internal/external stakeholders-Manage and upkeep of SOPs and Job Aids-Transition Coordination-Manpower Planning/ Work Allocation-Quality Planning and Quality Assurance-CSAT and ESAT -Reporting

-Review billing information, ensuring accuracy and clarify discrepancies-E-mail and verbal communication with internal and external customers-Analyze business information and data with strong attention to detail and accuracy-Implement organizational methods and procedures to proactively manage workload-Collaborate with Program team members to ensure project goals are met

-Create/Edit/Change Provider Demographic records in Facets-Attach agreements to provider records-Attach network agreement to provider records-Detailed analysis of provider demographic information

-Performs data transactions and maintenance associated with projects, expansions, and new product implementations -Maintains and updates provider demographic and contract info including contractually sensitive or complex transactions in the appropriate systems in support of claims adjudication and provider directory -Follow up on P1 pended claims to update pre-existing records -Works collaboratively with internal and external constituents to implement new networks and complex contractual agreements such as ancillary, facilities, hospitals and Provider Group specialties-Provide technical and functional leadership within the department -Manage, formulate, and submit rosters for delegated providers, deemed amendments and direct contracts using excel -Conducts and manages audits of provider information and escalates issues for solution when appropriate -Must be innovative when problem solving missing provider data and effectively complete tasks accurately and effectively while being accountable for all worked assignment -Run reports to find missing data elements in database for accurate data reporting -Coach and train new and tenured data analysts -Build and maintain Quality Check Guide and Job Aid using Excel and Microsoft Word-Prioritize, assign, and distribute new workload among the team

-Performs data transactions and maintenance associated with projects, expansions, and new product implementations -Maintains and updates provider demographic and contract info including contractually sensitive or complex transactions in the appropriate systems in support of claims adjudication and provider directory -Works collaboratively with internal and external constituents to implement new networks and complex contractual agreements such as ancillary, facilities, hospitals, and Provider Group specialties-Provide technical and functional leadership within the department -Provide/Maintain accuracy of data regarding providers requiring credentialing & re-credentialing-Manage, formulate, and submit rosters for delegated providers, deemed amendments and direct contracts using excel -Conducts and manages audits of provider information and escalates issues for solution when appropriate -Must be innovative when problem solving missing provider data and effectively complete tasks accurately and effectively while being accountable for all worked assignment -Run reports to find missing data elements in database for accurate data reporting -Coach and train new and tenured data analysts -Build and maintain Quality Check Guide and Job Aid using Excel and Microsoft Word-Prioritize, assign, and distribute new workload among the team

-Manage the internal and external referral process for members and providers using tools like excel while following state guidelines and policies-Provide demonstrations on processes and internal systems -Lead, train and manage teams in absence of upper management -Process Tricare referrals and notifications for all active duty and non-active-duty personnel and their families