The Vendor Program Specialist supports program operations and internal and corporate special projects such as compiling and analyzing information for the Division of Insurance filings, monitoring new state and federal regulations released and responding to report requests from state Medicaid programs or CMS. The Specialist works with the Vendor Managers to ensure the clinical vendors implement and are compliant with new regulations and requirements. Additionally, this position is responsible for managing the clinical vendor reporting and invoicing functions.

KEY FUNCTIONS/RESPONSIBILITIES:

Program Management

• Conducts the annual clinical vendor contract performance standard gap analysis, identifying performance standard variances. Works with Clinical Vendor Managers to align performance standards across vendors.
• Works with staff from Public Partnerships to identify changes to state/federal contracts and reporting requirements
• Accurately explains and walks through business processes such as reporting, invoicing, and portal access during annual internal, external, and regulatory audits.
• Develops and documents clinical vendor / clinical vendor management process flows, diagrams, and/or job aides to address gaps, operational efficiencies, or interdepartmental communications.
• Conducts competitive vendor and vendor management analyses and researches best practices within the industry for benchmarking purposes.

Project Management

• Implements clinical vendor management related projects such as conducting an annual regulatory contract requirement and Medicare Managed Care Manual gap analysis, developing and maintaining the team’s website and implementing efficiencies recommended through audits, by other internal departments, or by the clinical vendor management team.
• Provides project management support for new product implementations or other clinical vendor projects by:
  • Leading a project workgroup or sub-team
  • Implementing a key deliverable or work product
  • Setting up and managing the vendor implementation, product implementation, or project implementation work plan and action items

Reporting

• Investigates and identifies ongoing regulatory reporting specifications changes for all Plan product lines, and communicates the changes, timelines and impact to the internal clinical vendor management team as well as each of the clinical vendors.
• Evaluates and escalates adverse trends, issues, or discrepancies to Clinical Vendor Managers, internal Business Owners, and OCA leadership when processing internal and regulatory reports for CMS, and state contracts (NH and MA).
• Establishes quality control checks to ensure zero submission errors.
• Analyzes clinical vendor authorization, claims, call, provider, and utilization data.
• Works with OCA Sr. Business Process Engineer and Analyst to provide data for the CMO dashboard.
• Works with the NCQA Accreditation Manager to provide clinical vendor delegation reports and materials.

Operations Support

• Staff clinical vendor management meetings including the Clinical Vendor Oversight Committee, Joint Operating Committees, and regularly scheduled meetings between the Clinical Vendor Managers and Account Executives, by preparing agendas and ancillary documents, drafting meeting minutes and tracking/conducting post meeting follow-up.

• Organizes and maintains documentation (e.g. clinical vendor calendar) and resources on department shared drive including but not limited to vendor workflows, reference guides, training documents, performance standard summaries and policies. Updates vendor management documents (e.g. Clinical Vendor Grid) at least quarterly.

• Processes clinical vendor invoices and reports.

• OTHER VENDOR MANAGEMENT DUTIES AS ASSIGNED.

QUALIFICATIONS:

EDUCATION:

• Bachelor’s degree in Health Care Administration or related field, or an equivalent combination of education, training, and experience is required.

EXPERIENCE:

• 3 or more years of experience in a healthcare setting.
• Experience working on projects by using data analysis and gap analysis skills.

COMPETENCIES, SKILLS, AND ATTRIBUTES:

• Excellent oral and written communication skills required; ability to interact within all levels of the organization and external stakeholders.
• Proactive, motivated and collaborative team player.
• Ability to be flexible and work independently.
• Excellent organization and follow through skills.
• Strong data collection, analytical, accuracy, reporting, and problem solving skills.
• Ability to organize work, interpret policies, analyze and interpret data and prepare reports drawing logical conclusions.
• Detail oriented, excellent proofreading and editing skills.
• Experience with standard Microsoft Office applications (Outlook, Word, Excel, Access, PowerPoint, and Visio) is required.
• Ability to analyze, compile, format, and present findings, data, queries, and reports to a variety of stakeholders.
• Ability to manage multiple tasks and possess excellent organizational and time management skills.
• Ability to work in a fast paced environment and multi task.
• Ability to provide high quality customer service.

*Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status.

Required Skills Required Experience

LEADERSHIP • Supports Metro strategic goals to grow and sustain ridership, and to create a safer, more welcoming transit system for current, new, and former customers • Manages contractors and staff engaged in planning and related community engagement efforts • Collaborates regularly with other Agency staff (especially but not limited to staff from Planning & System Development, Economic Development, and Program Development/Engineering Systems) • Coordinates with external organizations, service agencies, and the general public to create initiatives that meet shared goals of improving mobility options for various demographic and socioeconomic populations in the region • Cultivates relationships with civic, community, local government, philanthropic, and private stakeholders to share data and build services/programs that meet partner needs • Serves as liaison between Metro and technical/government partners on planning initiatives

PLANNING • Manages major planning projects like Metro Reimagined, coordinating the analysis on such service enhancement projects, which includes: customer and community engagement, service scenario development/alternative analyses, and final recommendation reporting and presentation delivery • Meets with local officials and community groups to determine service needs, then develops and recommends service solutions to fulfill local demand in a cost effective manner. • Working closely with Metro staff and community partners, oversees the development of capital enhancement projects including place-making, service expansion, and multi-modal infrastructure investments. • Teams with Bi-State Development staff and external partners. on transit-oriented development (TOD) initiatives and projects. • Collaborates with Metro staff and planning partners to develop and provide regular updates of Metro’s long-range planning activities.

PROJECT MANAGEMENT • Identifies new opportunities and secures and manages resources (e.g. – grants, funding, personnel) needed to implement capital and operating enhancements/programs • Coordinates closely with Innovative Services Department on seeking resources for operational projects • Tracks and supports project implementation to ensure they meet Agency goals

Bi-State Development is an equal opportunity/ access / affirmative action/ pro-disabled and veteran employer. Bi-State Development is committed to providing an Equal Employment Opportunity experience for all employees, applicants, vendors and customers with an environment free of discrimination, harassment, and retaliation.