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Provider Network Performance Analyst
3 months ago
This role is hybrid in Cleveland, Ohio.
Responsibilities
Working under direct to general supervision, monitors the Company's provider network with respect to quality and utilization performance standards. Develops standard reporting and analytics to support Value Based Contracting (VBC) initiatives. Assists in supporting the contracting regions with quality, utilization, and cost analysis.
Provider Network Performance Analyst I
Gathers and maintains data from multiple sources and conducts quality assurance to identify potential errors or inconsistency.Creates monthly reporting package for distribution to VBC providers.Develops standardized PowerPoint presentations incorporating comparative analysis for Joint Operating Committee (JOC) meetings with providers.Assists with contract amendment development and review processes.Analyzes VBC Provider performance on a monthly basis through creation and maintenance of monthly dashboard.Collaborates with other departments to align value based contracting initiatives.Performs other duties as assigned.Provider Network Performance Analyst II
Conducts quality assurance analysis on data from multiple sources to identify potential errors or inconsistency.Develops Value Based Contract (VBC) amendments in collaboration with legal and assists with managing the amendment review and negotiation process with the contract representatives.Analyzes quality and utilization results as compared to contractual targets and project financial payments for accrual on a monthly basis.Analyzes final performance results and creates annual year over year VBC program performance information.Creates monthly reporting package for distribution to VBC providers.Develops standardized PowerPoint presentations incorporating comparative analysis for Joint Operating Committee (JOC) meetings with providers.Analyzes VBC provider performance on a monthly basis through creation and maintenance of monthly dashboard.Collaborates with other departments to align value based contracting initiatives.Performs other duties as assigned.Provider Network Performance Analyst III
Develops Value Based Contract (VBC) amendments in collaboration with legal and assists with managing the amendment review and negotiation process with the contract representatives.Conducts quality assurance analysis on data from multiple sources to identify potential errors or inconsistency.Analyzes quality and utilization results as compared to contractual targets and project financial payments for accrual on a monthly basis.Analyzes final performance results and creates annual year over year VBC program performance information.Works directly with contracting reps to problem solve VBC issues or questions from providers.Creates monthly reporting package for distribution to VBC providers.Develops standardized PowerPoint presentations incorporating comparative analysis for Joint Operating Committee (JOC) meetings with providers.Analyzes VBC provider performance on a monthly basis through creation and maintenance of monthly dashboard.Collaborates with other departments to align value based contracting initiatives.Orients, trains, and assists more junior level Analyst.Performs other duties as assigned.Senior Provider Network Performance Analyst
Monitors and oversees the Company's provider network with respect to quality and utilization performance standards. Provides necessary data to support contracting initiatives for the Provider Engagement (PE) department while working to implement value based contracting arrangements. Makes recommendations on process improvement opportunities with respect to performance against Value Based Contracting goals and objectives.
Develops and implements value based contracting arrangements.Analyzes and evaluates the performance of provider contracts to identify opportunities related to improvement of value based arrangement in the areas of HEDIS, Stars, and other quality/utilization related performance.Monitors the performance of provider contracts for compliance to contractual arrangements associated with value based contracting and makes recommendations for improvement.Develops and presents current performance information to VBC providers and internal stakeholders.Serves as subject matter expert to internal and external stakeholders for the Value Based Contracting program.Develops standardized language and provides responses for Request for Proposal (RFP) questions pertaining to Value Based Contracting.Collaborates with other departments to align value based contracting initiatives.Orients, trains, and assists more junior level Analyst(s).Performs other duties as assigned.