Provider Data Analyst

Job Summary: This position supports the Director, Provider Data Management.  Primary responsibility is to conduct a variety of analytical studies related to network provider data, provider analysis and interpretation of the issues and make recommendations related to the data issues.  Additionally, this position will manage future project integration with our network subcontractors, WPS and other downstream business users of provider data.

 

Key Responsibility Areas:

· Query and analyze data to identify; measure and trend issues with network provider data to ensure the integrity of network provider data.

· Research, analyze and interpret a wide variety of provider data and provide assistance to other departments to estimate the impact and identify resolution.

· Support the development of provider data standards for the Provider Services department.

· Maintain documentation and ensure that all procedures support the department and company policies and procedures.

· Analyze impacts to future system enhancements and edits.

· Coordinate with all interested parties to ensure smooth integration of system projects.

· Coordinate data analysis activities with various provider services staff who may serve as the source, end user or facilitator of required data.

· Perform other duties as assigned.

 

Working Conditions:

Favorable working conditions in a climate controlled office space; must be available for to cover any work shift; Works within an office environment with minimal travel required; level II IT security clearance.  There will be minimal travel (i.e. <10%)

 

Employment Standards:

 

Education and Experience:

Minimum five years experience in provider data management.  Five years of varied and responsible experience with data collection and report development, or any combination of education and experience that provides an equivalent background.  Health care/insurance industry experience is preferable.  Experience in Visual CACTUS preferred.

 

Knowledge, Skills and Abilities:

· Strong analytical and problem solving skills.

· Current knowledge of or ability to learn Word, Excel, Crystal Reports and Access or query language/software.

· Excellent oral and written communication skills.

· Familiarity with provider credentialing, claims processing and /or medical management decision-making support systems.

· Ability to track multiple projects independently.Ability to organize, manage, and prioritize multiple tasks.