Provider Operations Analyst II – Health Plan, Provider Data Experience

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

📋 Description

• Transform extensive and/or complex data into meaningful formats for tracking and status monitoring requirements.

• Create queries to pinpoint and quantify provider data issues while aiding in the development of resolution strategies.

• Provide analysis and oversight for provider data, workflows, and processes across Contracting, Credentialing, Data Load, Directories, and Pended Claims operations.

• Serve as Subject Matter Expert (SME), Business Analyst, and Data Analyst for Provider Operations initiatives and special projects.

• Collaborate across teams including Claims, Configuration, Market Representatives, and Provider Operations.

• Identify, design, and implement reporting and business processes that support data quality, operational excellence, and compliance requirements.

• Develop and track daily staff quality and productivity metrics, recommending necessary adjustments.

• Conduct root cause analysis for high-level escalations necessitating thorough research and resolution.

• Oversee special projects related to significant unpaid claims, state complaints, provider service risks, or compliance issues until resolved.

• Create, document, and execute testing and validation for changes in processes and systems.

• Act as the main contact for vendors and business partners involved in the exchange of CareSource provider data.

• Submit operational workflow requests to revise provider data.

• Work in conjunction with Talent Development to design and deliver training modules.

• Execute additional tasks as assigned.

⛳️ Requirements

• A Bachelor’s Degree or equivalent relevant work experience is mandatory.

• At least three (3) years of experience in health care or managed care is essential.

• Familiarity with Claims systems, particularly Facets, is preferred.

• Experience in provider relations, contracting, onboarding, credentialing, directories, pended claims, or configuration is highly desirable.

• Knowledge of one or more provider systems, such as Choreo/Contract Manager, Cactus, and Facets.

• Proficiency in SQL/Access.

• Advanced skills in MS Excel, PowerPoint, and Word.

• Strong capabilities in data analysis.

• Ability to comprehend workflows and facilitate process improvements.

• Exceptional organizational, collaboration, communication, facilitation, and presentation skills.

• Strong critical listening, thinking, and problem-solving abilities.

• Capacity to manage multiple initiatives and set priorities effectively.

• No licensure or certification is required.

• Occasional travel may be required, estimated at less than 10%.

🏝️ Benefits

• Bonus opportunities linked to both company and individual performance may be available.

• A substantial and comprehensive total rewards package is offered.

• An Equal Opportunity Employer environment that promotes belonging and support for individuals from diverse backgrounds.