Provider Network Data & Reporting Analyst - Community Health Options

Position Summary

Responsible for supporting, monitoring, identifying trends, and validating the Provider Network contracting effectiveness and cost management through financial and network modeling, analysis and reporting. Performs financial modeling to support well-informed negotiations, anticipating issues resulting in the ability to reach contract terms in good faith with community providers. The ability to work with constituents both internally and externally, and the ability to work well within a team environment (and independently) is critical to the success of this role.

Key Responsibilities

• Produces and analyzes ad-hoc reports to support departmental information and data needs as it relates to provider networks, provider participation, network management, network access standards, fee schedule comparisons, and claim utilization data.
• Assists with the development of departmental documentation including workflows, data dictionaries, change logs, and other recurring deliverables.
• Works to support and validate provider network contracting and unit cost management activities through financial and network pricing modeling, analysis, and reporting.
• Works with contracting team to identify cost savings opportunities and achieve budget targets within contracting initiatives.
• Creates reports summarizing the effectiveness of provider networks using baseline utilization metrics.
• Supports Provider Relations with tools (e.g. spreadsheets, analyses, and dashboards) to assist with provider outreach and network maintenance efforts.
• Analyzes, compares, and produces reports that provide competitive network information and recommendations.
• Assists with identifying areas where the most efficient and effective care is delivered.
• Conducts audits and provides feedback to reduce errors and improve processes and performance.
• Supports other cross-departmental reporting and project initiatives.

Requirements

• Bachelor’s degree in Business, Finance, Information Systems or related fields of study.
• 1-2 years of directly related healthcare business experience.
• Proficiency with analytical tools and software (Excel, SQL Server) and data visualization tools (Tableau, PowerBI).
• Excellent understanding of data structures, data modeling, and data warehousing
• Working knowledge of clinical data domains and code sets (CPT, ICD, DRG, etc.).
• Knowledge and experience within a healthcare environment.

Key Competencies

People within Community Health Options are expected to work with integrity, humility, strategic vision, curiosity, and discipline. They must be self-motivated, highly effective, and compassionate communicators, effectively working with people, work processes, and actively engaging in continuous process improvement.

Health Option diversity initiatives are applicable—but not limited—to our practices and policies on recruitment and selection; compensation and benefits; professional development, and training; promotions; transfers; social and recreational programs, and the ongoing development of a work environment built upon the premise of diversity equity, which encourages and enforces:

• Respectful communication and cooperation between all employees.
• Teamwork and employee participation, permitting the representation of all groups and employee perspectives.
• Work/life balance through flexible work schedules to accommodate employees’ varying needs.
• Employer and employee contributions to the communities we serve to promote a greater understanding and respect for diversity.