Provider Network Data Integrity Analyst

This is a fully remote position, open to applicants in Wisconsin.

📋 Description

• Ensure the precision, completeness, and adherence to regulations of the Health Plan’s provider network data.

• Execute network adequacy filings for CMS, NCQA, DHS, and requested employer groups.

• Create and implement data quality standards for provider and facility databases.

• Conduct network adequacy reviews in accordance with CMS time and distance standards.

• Carry out analyses and audits to pinpoint provider network deficiencies and guarantee their correction.

• Oversee regulatory provider network submissions and fulfill contractual responsibilities.

• Review and advise on provider credentialing data issues, including those concerning delegated credentialed entities.

• Keep the Health Plan Provider Directory updated in line with CMS, DHS, and Office of the Commissioner of Insurance requirements.

• Arrange extensive datasets into comprehensible formats for strategic planning purposes.

• Evaluate providers, facilities, and care patterns to uncover potential service-area expansion opportunities.

• Investigate and relay regulatory directives.

• Conduct disruption analyses for prospective Health Plan clients to enhance competitiveness in bids.

• Act as a resource for strategic planning, compliance, and network analysis.

• Execute additional tasks as assigned.

⛳️ Requirements

• Bachelor’s Degree in business administration, finance, healthcare-related field, computer science, or analytics.

• Three years of experience in a medical group practice, health insurance, or Health Maintenance Organization (HMO) setting.

• Proven expertise in data manipulation and analytical analysis.

• Proficient in Microsoft Office suite, including Excel and Access.

• Successful completion of a post-secondary medical terminology course is preferred.

• Familiarity with geoaccess coding, provider credentialing, and medical terminology is preferred.

🏝️ Benefits

• Salary range of $24.00 - $38.50 per hour.

• Full-time schedule with 40 scheduled hours per week.

• Option for remote work in Wisconsin.

• EEO/AA employer; equal opportunity for M/F/Disability/Vet.

• Support for reasonable accommodations for applicants with disabilities.