Network Adequacy and Access Analyst

POSITION SUMMARY

This position will work with other departments and providers in order to comply with Timely Access standards and regulatory reports requirements. The Analyst will ensure adherence to regulations by overlooking Timely Access Plan activities and reporting outcomes to the Director of Customer Experience.

COMPLIANCE WITH REGULATIONS:

Works closely with all departments necessary to ensure that the processes, programs, and deliverables are accomplished in a timely and efficient manner in accordance with CHG policies and procedures and in compliance with applicable state and federal regulations including CMS, DHCS and DMHC.Implements key quality strategies, which may include but are not limited to initiation and management of providers and corrective action plans.

RESPONSIBILITIES

• DMHC- Execution of Timely Access and Availability Program. Conducts
  Year over Year analysis and lessons learned (annual)
• Conducts PAAS ensuring all steps of the DMHC methodology are followed
• Updates Provider Contact Information for PAAS
• DHCS 274 File- Execution of Timely Access and Availability Program (quarterly)
• Pre-Natal- Execution of Timely Access and Availability Program (annual)

1. Includes secret shopping

• Responsible for CAP follow-ups and re-measurement of non-compliant and trending providers
• Owner of Timely Access policies and procedures
• Timely Access BPG Updates
• Facilitates Timely Access Work Group meetings
• Point of Contact for Third-Party Vendor activities (e.g. contract renewal, validation, file uploads)
• Responsible for Narrative for Contact Lists
• Responsible for Narrative for ANPRs
• Oversees Progress and Completion of Timely Access Report

1. Deliverables and Ensures Accuracy
2. Grievance Template
3. Contact Lists
4. External Vendor Validation Report

• Communicates and works with Compliance Department to research, investigate, or implement any Timely Access updates/communication from Regulators
• Analyzes and Trends Access Related Grievances
• Analyzes and Trends Access Related Inquiries; identifies opportunities for provider re-training
• Analyzes referral patterns to identify opportunities to optimize distribution
• Identifies opportunities to add PCPs, Specialists, Ancillary, NPMH Providers
• Provider Newsletter Articles- Timely Access Standards & other reminders
• Member Newsletter Articles- Timely Access Standards & other reminders
• Conducts onboarding and ongoing training of staff and providers in regards to appointment availability standards

Qualifications

Education:

Bachelors Degree

Experience:

• Knowledge of DMHC and DHCS Access and Availability Standards and methodology
• Experience with CAP monitoring and follow-up activities
• Experience with Regulatory Audits and meeting deadlines
• Extensive experience working with providers; management and executive staff

Skills:

• Excellent verbal and written communication skills
• Strong interpersonal skills
• Knowledge of regulatory processes and expectations
• Ability to manage multiple projects at any given time
• Ability to deal with sudden and upcoming changes and deadlines

Physical Requirements

• Prolonged periods of (up to 100%) sitting while performing duties
• Periodic (up to 25%) standing and walking
• Occasional traveling
• May be required to work evenings and/or weekends.

The above statements describe the general nature and level of work being performed. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified.

All qualified applicants will receive consideration for employment based on merit, without regard to race, color, religion, sex, national origin, disability, protected Veteran Status, or any other characteristic protected by applicable federal, state, or local law.