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We are driven by our common values of respect, discipline, relationships, culture, excellence, and fairness. We cultivate and value our partnerships that help us to achieve our shared vision of healthy, self-determining and vibrant BC First Nation Children, Families and Communities. Wish to have more than just a job? Consider joining the FNHA.

The First Nations Health Authority (FNHA) is dedicated to transforming health services for First Nations and Aboriginal people in BC. The FNHA and its employees are committed to a proactive and holistic approach to health and wellness for our communities and our staff. Our services are sustainable and honour and integrate the customs and traditions of BC First Nations.

PROVIDER RELATIONS & AUDIT MANAGER, HEALTH BENEFITS

VANCOUVER As the Provider Relations and Audit Manager (PRAM) you will assist in the development of strategies, policies, processes, and evaluation and research functions in health benefits. You will manage all processes related to provider audit and provider relationship management including provider registration for FNHA Health Benefits in benefit area’s such as Pharmacy, Dental, Medical supplies and Equipment, Vision, Medical Transportation, etc. You will provide ongoing reporting to support the functions within the provider registration and audit activities. You will collaborate with Manager of Reconciliation and Adjudication in managing the day to day provider registration and audit functions.

For more complete position information please visit:

FIRST NATIONS HEALTH AUTHORITY

WORK WITH US

The First Nations Health Authority is committed to respecting diversity within our workforce and specifically to increasing the number of First Nations and Aboriginal employees within our organization. We ask that all First Nations and Aboriginal applicants self-identify by indicating that you are First Nation or Aboriginal in the subject line of the email that accompanies your application package. Please note that preference may be given to qualified First Nations and Aboriginal applicants in our hiring processes.

APPLICATION DEADLINE: 4:00 pm July 04, 2014

Please email or fax your Cover Letter & Resume as 2 separate documents named in

the following format Last Name, First Name – Cover Letter

Last Name, First Name - Resume to

Email: careers@fnha.ca Confidential Fax: (604) 913-6135

Please include in the subject line of your email:

“Provider Relations & Audit Manager - 427”

and “Self-Identified” if you are self-identifying as First Nations or Aboriginal. Please indicate in your

cover letter where you initially became aware of the position

TITLE: Provider Relations and Audit Manager, Health Benefits

ORGANIZATION SUMMARY

The First Nations Health Authority (FNHA) and its employees are committed to a proactive holistic approach to health and wellness and are committed to the delivery of services which are sustainable and honour the customs and traditions of First Nations communities.

POSITION SUMMARY

As the Provider Relations and Audit Manager (PRAM) you will assist in the development of strategies, policies, processes, and evaluation and research functions in health benefits. The PRAM will manage all processes related to provider audit and provider relationship management including provider registration for FNHA Health Benefits in benefit area’s such as Pharmacy, Dental, Medical supplies and Equipment, Vision, Medical Transportation, etc. The position will provide monthly and adhoc reporting on ongoing bases to support the functions of FNHA within the provider registration and audit activities in the FNHA Health Benefits. The PRAM will collaborate with Manager of Reconciliation and Adjudication in managing the day to day provider registration and audit functions of a large third party contractor that provides adjudication services for Pharmacy, Dental and Medical Supplies and equipment.

REPORTING RELATIONSHIPS

This position reports to the Director, Program Analysis and Claims Adjudication

ACCOUNTABILITIES Lead all processes related to relationship management and audit including provider registration in benefit area’s

such as Pharmacy, Dental, Medical supplies and Equipment, Vision, Medical Transportation, etc for FNHA

Establish processes and measures to ensure adequate checks and balances within the Health Benefits System.Highlight red flag and potential risk areas along with prevention initiatives in the Health Benefits function

Conduct analysis and prepare audit reports, summaries and other documents as required related to HealthBenefits programs and initiate corrective action if required

Report outcomes of data analysis using various methods including graphing, charting and written summaries,including the identification of trends, variances, % to budget, anomalies, etc.

Provide program analytics, information and interpretation to management and staff, including those in regionsas well as stakeholders and health system partners

Lead in the monitoring and evaluation of a large and complex third party claim adjudicator as it relates toProvider Audit and Registration in collaboration with Manager of Reconciliation and Adjudication

Conduct, interpret and summarize analysis on a variety of program areas and document findings for a variety ofaudiences and uses, including policy development, evaluation and measurement, etc.

Identify program trends using analytics and establish KPI’s in areas such as provider service quality, providerregistration, audit identification and outcomes, etc.

Manage the day to day activities in auditing providers and clients to ensure Health Benefits Program integrityand accountability. The incumbent will be expected to provide senior management with analytics along withrecommendations for future provider registration requirements, service delivery levels, policy, processes /procedures, etc.

Manage the day to day activities of registering new providers, monitoring existing providers.

Lead staff in a wellness based organizational environment and including all areas of HR management including but not limited to job profiling, resourcing (staffing & recruitment, learning and development and performance management

Participate on internal, bilateral and/or tripartite committees

Attend, take notes and summarize meetings, including management of follow up items, including briefings of the Director and others

Lead and/or participate in project teams and working groups

QUALIFICATIONS

Education

University degree in Statistics, Business Analytics, Public Administration or Business Administration.

Experience

6 to 8 years Recent, relevant and significant experience in data analysis, manipulation and interpretation, preferably in the health sector health

5 to 7 years Recent, relevant and significantly progressive experience in management of teams and staff

Expert Experience in data analysis as it relates to provider registration and/or audit within a large organisation

Experience in exporting and analyzing large amounts of data using Microsoft Excel, or other relevant tools

Expert Experience working with office productivity software (Microsoft Office suite of products – Word, Excel, PowerPoint, Outlook, Project and Access)

Experience managing a budget, vacation and related operational requirements

Experience in establishing KPI’s within audit and/or provider registration

Experience with health care fraud detection within a health care environment is an asset

Experience in using data analysis tools such as SPSS,SAD, Tableau, etc. is an asset

Experience working with BC First Nations communities is an asset

Knowledge

Expert knowledge in the selection and use of data analysis tools

Expert knowledge with office productivity software such as Access and Excel.

Knowledge of health related systems, policies and issues in general and as they relate to First Nations in BC

Knowledge of Privacy legislation and its impact on the use of data

Expert knowledge of Audit methodologies

Expert knowledge of provider registration methods

Expert knowledge of provider relationship building techniques

Abilities

Ability to analyze and apply critical thinking to perform data analysis and interpretation of business requirements as it relates to the audit, provider registration and maintaining provider lists by and utilizing numbers, trends and data to drive evidence based decision making

Ability to deal with ambiguity, multiple project demands and changing business priorities in a fast paced and high work volume work environment

Ability to work independently, collaboratively and as part of a multi-disciplinary team in a wellness based organizational environment

Ability to make sound and informed decisions, utilizing sound judgment

Ability to effectively manage staff and project teams

Ability to communicate effectively, both orally and in writing, including the ability to translate complex concepts into easily understood and audience appropriate briefing notes, reports and presentations

Ability to efficiently and effectively utilize Microsoft Office Suite including Word, Outlook, Powerpoint and Excel

Suitabilities

Tact, discretion and reliability

High degree of initiative

Working Conditions

The work requires unplanned overtime and attendance at meetings after hours

The work requires travel throughout the Region and BC