Healthcare Operations Analyst

Job Description:

• Manage Non-Quantitative Treatment Limits (NQTL) portion of parity assessment, including:
• Attend internal and off meetings with QTL/NQTL team.
• Prepare NQTL carrier data requests on behalf of each client:
• Review member facing vendor documents such as summary plan designs, summary of benefits, etc.
• Monitor carrier and vendor responses to data requests.
• Prepare initial review of carrier responses for parity projects.
• Determine the appropriate results and recommendations necessary for parity concerns and findings for various NQTLs and collaborate with MHPAEA Technical Reviewer to determine accuracy of language used.
• Coordinate with project manager regarding sending requests, timing, status, and follow-up.
• Validate completeness of response and report any issues or impact to timeline proactively to project manager.
• Map carrier responses to appropriate section of NQTL document
• Collaborate with health management senior reviewer and project manager to conduct follow up calls/emails with carriers/vendors as needed for clarification and submission of additional documents.
• Support the overall completion of the NQTL component of the report.
• Schedule meetings and coordinate efforts of colleagues
• Participation in weekly or bi-weekly project status calls as needed.

Qualification:

• At least 3 years of working experience dealing with US health and welfare plans, US healthcare, Medical Managed Care (inpatient, outpatient services)
• Understanding of health plan utilization/case management processes, network management, credentialing, quality management, pharmacy prior-authorization processes and health plan operations
• Proficiency in English – external comms w/ vendors
• Project Management skills
• Willing to work in Hybrid set-up (2x per week)

Job Type: Full-time

Pay: Php35,000.00 - Php45,000.00 per month

Schedule:

• Night shift

Work Location: In person