Senior Provider Network Analyst
Delegation Oversight & Regulatory Reporting
Under general supervision, responsible for developing and creating complex regulatory and internal reports and analysis, related to provider data.Under general supervision, responsible for developing and creating complex regulatory and internal reports and analysis, related to provider data.Under general supervision, responsible for developing and creating complex regulatory and internal reports and analysis, related to provider data.
What you'll do:
- Gathers and reviews requirements and determines resources required.
- Identifies, validates, integrates and compiles data from a variety of sources, using SQL scripts and other tools.
- Analyzes, interprets and models data, identifying variances and trends; makes recommendations based on findings.
- Documents requirements to ensure traceability throughout the report development process.
- Negotiates project scope and communicates risk of scope creep.
- Conducts appropriate testing based on internal standards to ensure report accuracy; sets expectations with business users around user acceptance testing and design review.
- Performs and participates in peer review; identifies issues and escalates to management.
- Participates in and makes recommendations for the work stream planning process.
- Collaborates with external and internal stakeholders to maintain the validity, integrity, and relevance of data sources.
- Prepares for internal and external audits, and participates in the preparation of recommendations, responses and reports.
- Intermediate skills in dashboard development, including but not limited the ability to create meaningful dashboards to customers’ satisfaction.
- Advanced skills in SQL Query development, including but not limited to the ability to write complex SQL scripts for testing, reports, and Tableau data connections and others as required.
- Intermediate programming skills, including but not limited to writing complex queries to extract data per State and federal regulatory requirements.
- Intermediate skills in report development with ability to develop reports in SSRS, Business Objects, or equivalent tool.
- Advanced skills in data visualization tools, including but not limited to the ability to create ad-hoc data connections, developed dashboards, and create data blending.
- Advanced documentation skills, including but not limited to the ability to capture requirements and technical specifications using IEEE or similar standards.
- Produces work that is accurate and complete.
- Produces the appropriate amount of work.
- Actively learns through experimentation when tackling new problems, using both successes and failures to learn.
- Rebounds from setbacks and adversity when facing difficult situations.
- Knows the most effective and efficient process to get things done, with a focus on continuous improvement.
- Strong business acumen, with the ability to understand the operations and challenges in the provider network department as well as other business units and how the organization’s information assets may be leveraged to provide solutions.
- Interpersonal skills - interacts effectively with individuals both inside and outside of HPSJ; relates openly and comfortably with diverse groups of people.
- Strong oral and written communication skills, with ability to communicate complex technical issues to technical and non-technical audiences and write technical specifications.
- Strong listening skills, with the ability to accurately receive and understand messages.
- Demonstrates a commitment to HPSJ’s strategy, vision, mission and values.
- Strong problem solving and analytical skills, with ability to determine key issues, develop effective action plans and implement to successful conclusion.
- Time management and organizational skills. Uses time effectively and efficiently. Values time. Concentrates his/her efforts on the more important priorities. Can attend to a broader range of activities. Meets deadlines.
- Basic knowledge of claims payment systems.
- Basic knowledge of comparative analysis and cost benchmarking of different reimbursement strategies, including but not limited to, fee-for-service, capitation, per diem, case rates and other payment approaches.
- Basic knowledge of researching and utilizing external data sources for competitive intelligence and benchmarking.
- Ability to work independently and as part of a team.
- Intermediate skills in Windows, Word, Excel and Outlook.
- Ability to speak and be understood in English.
- Ability to handle confidential information with appropriate discretion.
- Knowledge of healthcare specific hardware and software with the ability to extract data from the healthcare system for reporting
- Knowledge of QNXT claims payment system and Cactus provider system with the ability to extract data for reporting
- Skills in Visio or other flow chart/diagramming software, with ability to create data/process flow diagrams from business requirements
- Advanced skills in Excel, including but not limited to the ability to create complex formulas
- Skills in Agile Scrum development.
- Master’s Degree in Computer Science, Management Information System, Computer Information System; or related field; and
- At least six years as a data analyst in a Medi-Cal, Medicaid or managed care plan; or
- Equivalent combination of education and experience.
- Experience in healthcare and/or managed care.
License, Certification, Registration
- MSCE Business Intelligence