The Provider Data Analyst is responsible for executing all activities and processes related to the management and maintenance PCHP’s healthcare provider records. The Provider Data Analyst will interact with the internal and external matrix of subject matter experts and stakeholders involved in managed care contacting, credentialing, and onboarding of our healthcare providers, including but not limited to; delegated credentialing provider groups, claims and configurations team, provider relations, credentialing, government agencies and contractors, etc. The Provider Data Analyst will independently manage inventory and cycle times associated with the provider onboarding life cycle. This individual will also be responsible for adhering to policies and procedures and driving continuous process improvement. Goals and objectives of this position include positive member and provider experience, accurate Provider Directory, regulatory compliance, and accurate claims adjudication and payment remittance.
High school diploma or equivalent required.
Bachelor's degree in Business Administration, Public Administration, or a related field is preferred.
Three (3) years of professional experience in a healthcare/health plan organization, with two (2) of those years working in a data analyst, data support, or data administration role.
Prior experience with provider relations, credentialing, claims processing systems preferred.
Equivalent Education and/or Experience
May have an equivalent combination of education to substitute for the experience requirements.
Skills or Special Abilities
Broad knowledge of health insurance industry philosophy, terminology, methods, and practices.
Ability to navigate and influence the health plan and service center resource matrix.
Knowledge and exposure to healthcare claims processing systems and workflow.
Hands-on experience in a related customer/client/provider facing service role.
Demonstrated ability to support, develop and execute performance improvement strategies.
Written and verbal communication skills, including the ability to influence, negotiate and interact effectively with a diverse range of subject matter experts and business stakeholders.
Detail oriented with independent problem-solving drive.
Proficient in Microsoft suite of software; Excel, Power Point, Word, SharePoint.
Demonstrated ability to work effectively within a team and lead projects in a fast-paced environment.
Executes the workflow between PCHP healthcare providers, PCHP Network Development team, PCHP Credentialing team, and PCHP Provider Configurations team.
Responds to internal and external customer inquiries.
Manages the inventory of work queue volume to ensure all cycle time requirements are satisfied.
Facilitates natural work teams/meetings needed to support the Provider Data Management workflow.
Conducts Quality/Accuracy audits of provider originated data submissions against the corresponding system configurations
Leads the workflow surrounding claims research and reconciliation projects and root cause resolution.
Leads continuous process improvement efforts to achieve workflow efficiencies and work queue management.
Supports continuous Provider training and education campaigns.
Ensures adherence to state (HHSC, TDI) and federal compliance policies (CMS), reimbursement policies and contract compliance (PCHP).
Completes and documents routine qualitative and quantitative analysis of Provider Data and Provider Directory.
Complete data validation processes specific to provider data received to ensure accuracy prior to entry
Identify issues that require additional investigation and evaluation, validate discrepancies incurred, and ensure appropriate follow up.
Identifies ways to improve work processes and improve customer satisfaction. Makes recommendations to supervisor, implements, and monitors results as appropriate in support of the overall goals of PCHP.
Stays abreast of the latest developments, advancements, and trends in the field by attending seminars/workshops, reading professional journals, actively participating in professional organizations, and/or maintaining certification or licensure. Integrates knowledge gained into current work practices.
Maintains knowledge of applicable rules, regulations, policies, laws, and guidelines that impact the area. Develops effective internal controls designed to promote adherence with applicable laws, accreditation agency requirements, and customer requirements. Seeks advice and guidance as needed to ensure proper understanding.
Parkland Health and Hospital System prohibits discrimination based on age (40 or over), race, color, religion, sex (including pregnancy), sexual orientation, gender identity, gender expression, genetic information, disability, national origin, marital status, political belief, or veteran status.
Nearest Major Market: Dallas
Nearest Secondary Market: Fort Worth
Job Segment: Data Analyst, Quantitative Analyst, Patient Care, Healthcare Administration, Business Process, Data, Healthcare, Management