Hybrid Data Management Lead at Government Employees Health Association, Inc.

GEHA (Government Employees Health Association, Inc., pronounced G.E.H.A.) is a nonprofit member association that provides medical and dental benefits to more than two million federal employees and retirees, military retirees and their families. We celebrate diversity and are committed to creating an inclusive environment for all employees.

GEHA has one mission: To empower federal workers to be healthy and well.

Offering one of the largest medical and dental benefit provider networks available to federal employees in the United States, GEHA empowers health and wellness by meeting its members where they are, when they need care. We serve our members with products they value and a personalized customer experience, sustained by a nimble and efficient organization. 

Supports PDM management and staff with workflow, reports, audit rebuttals, and complex provider updates and phone calls. Works under minimal supervision and provides guidance to lower levels.

SKILLS

• Monitors the workflow of Provider Data Management staff.
• Prepares responses to correspondence and handles assigned projects.
• Answers questions from Provider Data Management staff regarding format and procedures for various provider records. Handles reviews of specific provider situations as requested.
• Reviews and audits debarred, and suspended provider reports received from OPM/OIG.
• Handles priority pre-certification cases.
• Functions as a lead or back-up in the absence of the Supervisor Provider Data Management.
• Updates and completes daily, monthly, and annual reports.
• Makes recommendations to improve quality, workflow processes, policies and procedures.
• Contributes independently and collaboratively across departments and cross-functional projects.
• Analyzes audit reports and rebuttals to identify trends and recommend determination of outcome. 
• Provides training on desk level procedures and policies. Conducts desk level procedure retraining when needed.
• Audits claims coding, customer service calls or electronic files for accuracy, benefit payment, contract interpretation, and compliance with policies and procedures as needed.

• Requires high school diploma or equivalent.
• Requires three years’ experience as a Provider Data Management Rep or three years claims processing proficiency using Facets.
• Requires seven plus years of data entry experience.
• Requires effective written and verbal communications skills to answer questions from staff and respond to inquiries.
• Requires analytic ability to prepare departmental reports. Requires the ability to compare data and resolve discrepancies.
• Must have thorough knowledge of Provider Data Management policy and procedures.
• Requires proficiency with Word and Excel.

PREFERRED:

• Experience as an Associate Quality Assurance Specialist within PDM

Work-at-home requirements

• Must have the ability to provide a non-cellular High Speed Internet Service such as Fiber, DSL, or cable Modems for a home office.
• A minimum standard speed for optimal performance of 30x5 (30mpbs download x 5mpbs upload) is required.
• Latency (ping) response time lower than 80 ms
• Hotspots, satellite and wireless internet service is NOT allowed for this role.
• A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

How we value you

• Competitive pay/salary ranges
• Incentive plan
• Health/Vision/Dental benefits effective day one
• 401(k) retirement plan:  company match – dollar for dollar up to 4% employee contribution (pretax or Roth options) plus a 6% annual company contribution   
• Robust employee well-being program
• Paid Time Off
• Personal Community Enrichment Time
• Company-provided Basic Life and AD&D
• Company-provided Short-Term & Long-Term Disability
• Tuition Assistance Program

Please note that the salary information is a general guideline only.  GEHA considers factors such as (but not limited to) scope and responsibilities of the position, candidate’s work experience, education/training, key skills, internal peer equity, as well as, market and business considerations when extending an offer.

The annual base salary range for this position is $49,050 - $69,142 USD.

GEHA is an Equal Opportunity Employer, which means we will not discriminate against any individual based on sex, race, color, national origin, disability, religion, age, military status, genetic information, veteran status, pregnancy, marital status, gender identity, and sexual orientation, as well as all other characteristics and qualities protected by federal, state, or local law. GEHA will not discriminate against employees or applicants because they have inquired about, discussed, or disclosed their compensation or the compensation of another employee or applicant. We are committed to creating an inclusive environment for all employees. Our diversity drives innovation deepens connections and strengthens our organization.

GEHA is headquartered in Lee's Summit, Missouri, in the Kansas City area. We recognize the importance of balance and flexibility and offer hybrid and work-from-home options for many of our roles. 

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