Provider Network Analyst Sr

Responsibilities:

Responsible for research and analysis related to provider network issues.  Supports new business provider recruitment and contracting or responsible for research and analysis related to provider claims issues.  Identifies systematic and procedural issues resulting in processing reports and initiating actions to produce reports.  Extracts manipulates, and evaluates accuracy of provider data for new implementations or responsible for ensuring plan stays in compliance with provider contracts. 

Gathers complex statistical data analysis to identify financial and non-financial impacts and process and system improvements.   Uses provider contract maintenance software to create provider contract templates and creates files associating contract templates and other credentialing forms.  Assists with and coordinates configurations and testing and generates new reports as required.

Education/ Experience:

• Bachelor’s Degree.
• Bachelor’s Degree (i.e., Business) or an equivalent education and experience.
• Facets configuration knowledge. Building queries using SQL, MS Access, or other technical analysis tools.
• 1-2 years managed care or related experience.   
• Advanced experience with sophisticated databases with 3-5 years analytical experience in the Healthcare industry.          

Other Skills:

• Superior analytical skills.
• Proficiency with Microsoft Office Suite (Word, Excel, Power Point).
• Full competence in report preparation, layout and design.  
• Ability to plan, organize and handle multiple tasks.