Provider Network Analyst Assistant

Support the Provider Network Analyst and Network Management team as needed. Update and compile reports for Health Plans, Providers and internal departments. Support the Department in completing and tracking of Client audits. Learn various internal software to assist in utilization reviews and adequacy of provider networks.

  • Assist the Provider Network Department in completing monthly and quarterly reporting requirements to its Clients
  • Requires strong analytical skills to thrive in a fast paced environment as well as be comfortable with management exposure.
  • Refresh the data files monthly of the current health plans in order to review the Network adequacy of our provider specialties.
  • Assist department in reviewing network accessibility (including quarterly geo-map analysis).
  • Assist department in annual audits from health plans.
  • Refresh the data to analyze the claims utilization and cost performance of the specialty networks.
  • Assist department in reviewing network accessibility (including quarterly geo-map analysis).
  • Work on various special projects and ad-hoc reports on an as needed basis.
  • Work and support multiple members of the department conducting research via the internet, internal software programs, spreadsheets, health plan directories, etc. to support the department with current and new projects. Research information may be requested in various reporting formats.
  • Must support company philosophies, objectives, decisions and policies.
  • Ensure adherence to department and organizational standards, policies and procedures, including HIPAA.
  • Ensure integrity of data entered into Company systems and/or databases.
  • Ability to safely and successfully perform essential job functions consistent with the ADA, FMLA, and other federal, state, and local standards, including meeting qualitative and/or quantitative productivity standards.
  • Ability to come to work and work the regular schedule and shift for the position.
  • Compliance with all personnel policies and procedures.

Other Duties

  • Ability to work both independently and as part of a team of professionals.
  • Excellent analytical and problem solving skills.
  • Proficient in Excel, knowledge in Access, GEOmaps, SQL
  • Must have strong organizational skills, and have the ability to Multi-task.
  • Strong interpersonal and verbal and written communication skills.
  • Flexible and adaptive. Maintains effectiveness when experiencing major changes in work tasks or the work environment; adjusts effectively to work within new work structures, processes, requirements, or cultures.
  • Knowledge of with various aspects of billing, claims adjudication and claims payment for the network specialties. This should include, but may not be limited to Medical terminology, CPT Coding, ICD Code Sets, and CMS Fee Schedules.

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Education and/or Experience

  • Bachelor's degree or equivalent work experience in data analysis experience.
  • Two or three years background in the managed care industry.

Certificates, Licenses, Registrations

Not applicable to this position.

Supervisory Responsibilities

Not applicable to this position.

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