Provider Directory Assurance Analyst- Hybrid

3 weeks ago


Los Angeles, United States CareerBuilder Full time

Job DescriptionJob 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

Complete monthly, quarterly, semi-annual, annual Health Plan, State or Federal requested Provider Directory/Network validation Reports Prepare Provider Network Reports for Hospital & Health Plans Ops, Utilization Management, Credentialing, and Compliance departments

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

Prepare Bi-Monthly Reports to aid in Provider Outreach efforts to maintain database accuracy

Perform monthly quality assurance of Client databases to ensure compliance with regulatory requirements

Communicate effectively with various internal departments to enhance cross-functional awareness, promote process improvements and identify issues

Assist in various mandatory projects such as data cleanup, workflow revisions, and upkeep of maintenance

Prepare ad-hoc reports as needed by MedPOINT or Client Leadership Teams

Foster open lines of communication with Leadership on any network changes or issues

Perform additional duties/assignments as needed

Minimum Job Requirements

High School Diploma or GED required, Bachelors degree in healthcare, human services or related field preferred

Proficient in Microsoft Office Suite (Word, Excel, PowerPoint, Outlook)

Access, SQL, SPSS knowledge, a plus

EZ-CAP knowledge and experience, a plus

Skills and Abilities

Proven ability to identify, analyze, and interpret trends or patterns in intermediate data sets

Ability to multi-task, exercise excellent time management, and meet multiple deadlines

Excellent attention to detail, with the ability to communicate and document information accurately

Ability to work independently and take direction

Ability to quickly learn and use new software tools

Demonstrate commitment to the organizations core values

Ability to provide and receive constructive job-related feedback

Communicates effectively and works well in a team

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