Provider Directory Assurance Analyst- Hybrid

4 days ago

Los Angeles, United States ZipRecruiter Full time

Job Description

Summary

Under the general direction of Provider Network Operations (PNO) Project Manager, the Provider Directory Assurance Analyst is responsible for ensuring accurate, timely, and efficient reporting of Client IPA provider network data to the Health Plans, State or Federal entities. This position's primary functions are managing scheduled and ad-hoc reporting needs, troubleshooting data integrity issues, and analyzing data. The Provider Directory Assurance Analyst will play a significant role in supporting the department's strategic goals.

Duties and Responsibilities

  1. Complete monthly, quarterly, semi-annual, and annual Health Plan, State or Federal requested Provider Directory/Network validation Reports.
  2. Prepare Provider Network Reports for Hospital & Health Plans Ops, Utilization Management, Credentialing, and Compliance departments.
  3. Work closely with the PNO Database and Network Management team to ensure reconciliation data received from the Health Plans are updated in the respective Client database.
  4. Prepare Bi-Monthly Reports to aid in Provider Outreach efforts to maintain database accuracy.
  5. Perform monthly quality assurance of Client databases to ensure compliance with regulatory requirements.
  6. Communicate effectively with various internal departments to enhance cross-functional awareness, promote process improvements, and identify issues.
  7. Assist in various mandatory projects such as data cleanup, workflow revisions, and upkeep of maintenance.
  8. Prepare ad-hoc reports as needed by MedPOINT or Client Leadership Teams.
  9. Foster open lines of communication with Leadership on any network changes or issues.
  10. Perform additional duties/assignments as needed.

Minimum Job Requirements

  1. High School Diploma or GED required, Bachelor’s degree in healthcare, human services or related field.
  2. Proficient in Microsoft Office Suite (Word, Excel, PowerPoint, Outlook).
  3. Access, SQL, SPSS knowledge, a plus.
  4. EZ-CAP knowledge and experience, a plus.

Skills and Abilities

  1. Proven ability to identify, analyze, and interpret trends or patterns in intermediate data sets.
  2. Ability to multi-task, exercise excellent time management, and meet multiple deadlines.
  3. Excellent attention to detail, with the ability to communicate and document information accurately.
  4. Ability to work independently and take direction.
  5. Ability to quickly learn and use new software tools.
  6. Demonstrate commitment to the organization’s core values.
  7. Ability to provide and receive constructive job-related feedback.
  8. Communicates effectively and works well in a team.
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