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    Health Management Analyst - Taguig City, Pilipinas - TASQ Staffing Solutions

    TASQ Staffing Solutions
    TASQ Staffing Solutions Taguig City, Pilipinas

    1 linggo ang nakalipas

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    Paglalarawan

    This position is responsible for providing support to US-based Health and Benefits Consultants. Within this role, as a member of a North American client team, you will collect and analyse data that inform strategic business decisions. The expectation will be to efficiently and accurately produce several client-facing reports.

    Your role will serve as the analyst for US Mental Health Parity and Addiction Equity Act (MHPAEA) non-quantitative treatment limit (NQTL) projects.

    Your individual role will include meeting/deliverable management elements such as project kick-offs, project status/meeting minutes, preparing data requests, facilitating data collection, data review, preparing gap analysis (PPT) results summary, and other activities.

    As part of this role, you will manage emails with the vendors and internally to support projection completion. You will review vendor responses and compile NQTL findings, highlight potential gaps in compliance, map to existing processes, and more. This analysis will compare current NQTL mental health/substance use disorder (MH/SUD) limits, processes, factors, and criteria, in addition to MH/SUD coverage versus medical surgical coverage.

    You will continually learn about North American health and benefits concepts and principles and apply these skills in a global environment. Finally, you will interact with other members of our United States Health and Benefits team and can make important contributions to process improvements and new analytical tools.

    This position requires a clinical mind who is detail-oriented with work products and outputs using Microsoft Office tools. The position also requires the ability to accurately execute written and verbal instructions.

    The Role

    Manage the Non-Quantitative Treatment Limits (NQTL) portion of parity assessment, including:

    • Attend internal and off meetings with the 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 an 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 the MHPAEA Technical Reviewer to determine the accuracy of the language used.
      • Coordinate with the project manager regarding sending requests, timing, status, and follow-up.
      • Validate completeness of response and report any issues or impact on the timeline proactively to the project manager.
      • Map carrier responses to the appropriate section of the 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.
    • Participate in the MHPAEA roundtable as needed.
      Maintain materials/documentation in a manner consistent with the company work processes and peer review standards (e.g., filing of drafts, deliverables, client, and carrier documentation)

    Requirements:

    • 3+ years of working experience dealing with US health and welfare plans, ideally gained in a benefits consulting/brokerage firm, Health Plan, Third Party Administrator, Regulatory Agency, Legal/Compliance Firm, or insurance company. Prior experience working with US-based consulting or healthcare firms is a plus.
    • MUST have US Healthcare Experience & Medical Managed Care or Prior authorization, Project Management.
    • Understanding of US health plan utilization/case management processes, network management, credentialing, quality management, pharmacy prior-authorization processes, and health plan operations
    • Basic understanding of Mental Health Parity regulations
    • Intermediate knowledge and experience in MS Office particularly in Microsoft Excel and PowerPoint
    • Excellent oral and written communication skills in English
      Strong communication and collaboration skills:
      • Client service orientation and ability to respond to all communications effectively and in a timely manner.
      • Ability to ask the right questions and seek help where appropriate from colleagues and clients.
      • Ability to collaborate and work across all levels of the organization, work in teams, leverage the resources of other related groups to accomplish common objectives, and work on virtual teams across geographies.
    • Responsible, proactive, self-starter, and can work individually and as part of a team.
    • Strong critical and analytical skills:
      • Strong analytical, creative, and integrative skills
      • Must possess strong critical thinking capabilities and the willingness to apply skills proactively, well-organized, and detail-oriented.
      • Flexibility and proven ability to identify and resolve issues.
    • Project and time management Skills
      • Project management skills are required; the ability to work on multiple tasks in a fast-paced environment while adhering to strict deadlines is a must.
      • Strong client service orientation and ability to respond to all communications effectively and in a timely manner.
      • Continuous improvement mindset
      • Ability to quickly transfer learning into practice.
    • Amenable to work on the night shift.
    • Amenable to work in a hybrid setup (2x WFH/week)
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