Provider Network Data Integrity Analyst, Health Plan

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

📋 Description

• Accountable for the precision, thoroughness, and necessary regulatory submissions of the Health Plan’s provider network.

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

• Conducts network adequacy assessments in partnership with representatives from the Health Plan's Business Intelligence Department.

• Executes analyses and audits to pinpoint deficiencies in existing provider networks.

• Oversees mandatory regulatory submissions related to the provider network to ensure compliance with contractual commitments.

• Ensures the accuracy of data within the HP Provider Directory.

⛳️ Requirements

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

• Preferred: Successful completion of a post-secondary medical terminology course.

• A minimum of three years’ experience in a medical group practice, health insurance, or Health Maintenance Organization (HMO) environment.

• Proven expertise in data manipulation and analytical analysis.

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

• Preferred: Familiarity with geoaccess coding, provider credentialing, and medical terminology.

🏝️ Benefits

• Health insurance

• Retirement plans

• Paid time off