Provider Directory Assurance Analyst- Hybrid
3 weeks ago
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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