Teams at Neighborhood Health Plan of Rhode Island

Leads healthcare quality analytics projects focused on HEDIS, Medicaid, Medicare, and clinical quality performance. Analyzes claims, provider, member, pharmacy, and clinical data; develops reports and HEDIS files; validates data accuracy; supports quality improvement interventions; and advises management and external partners. Serves as a SAS and SQL subject matter expert, mentors analysts, coordinates multidisciplinary projects, and communicates findings to stakeholders.

Supports provider outreach, education, compliance tracking, and issue resolution for a managed care organization. Maintains provider data, training records, distribution lists, and Salesforce reports; responds to provider inquiries; educates providers on health plan policies; and collaborates across departments to improve provider satisfaction, compliance, and network operations.

Coordinates intake, assignment, tracking, correspondence, and resolution monitoring for Medicaid, Medicare, and Commercial grievances and appeals. Manages external appeals, maintains secure electronic records, monitors regulatory deadlines, coordinates with internal departments and delegated entities, reviews compliance forms with Legal, and supports team training. Requires strong organization, communication, analytical, customer service, healthcare systems, and regulatory knowledge.