Interested in a career with both meaning and growth? Whether your abilities are in direct patient care or one of the many other areas of healthcare administration and support, everyone at Parkland works together to fulfill our mission: the health and well-being of individuals and communities entrusted to our care. By joining Parkland, you become part of a diverse healthcare legacy that’s served our community for more than 125 years. Put your skills to work with us, seek opportunities to learn and join a talented team where patient care is more than a job. It’s our passion.

 

Primary Purpose

Parkland Community Health Plan’s (PCHP’s) Provider Data Management (PDM) Analyst is responsible for maintaining and updating provider data within the health plan's systems to ensure accuracy, timeliness, and compliance with regulatory requirements.

 

Minimum Specifications

 

Education

Bachelor’s degree in healthcare administration, business administration, information systems, or a related field required.

 

Experience

Three years of provider data management experience, including: Experience managing and submitting regulatory files, including Medicaid provider files and the Master Provider File (MPF), with an understanding of compliance requirements. Experience with QNXT or similar claims management & provider data systems required.

 

Equivalent Education and/or Experience

May have an equivalent combination of education and/or experience in lieu of specific education and/or experience as stated above.

 

Skills or Special Abilities

Excellent verbal and written communication skills including the ability to communicate effectively and professionally across disciplines and cross functional teams. Ability to communicate complex information in understandable terms. Strong interpersonal and conflict resolution skills with the ability to establish and maintain effective working relationships across and beyond the organization. Excellent analytical, attention to detail, organizational, and problem-solving skills. Strong technical knowledge of healthcare configuration systems (e.g., QNXT). Proficiency in data analysis and testing methodologies. Knowledge of regulatory compliance requirements for provider data and claims systems. Strong time management and organizational skills with the ability to manage multiple demands and respond to rapidly changing priorities. Ability to write clearly and succinctly with a high level of attention to detail. Proficient computer and Microsoft Office skills and other analytical tools. Ability to learn new software programs. Knowledge of Texas Medicaid, National Committee for Quality Assurance (NCQA), the Uniformed Managed Care Contract, and the Uniform Managed Care Manual.

 

Responsibilities

Operations

Ensure timely and accurate updates to provider data in systems, including provider demographic changes, terminations, and additions. Create and update documentation for provider data maintenance processes. Respond to inquiries related to provider data from internal teams, such as Claims, Operations, and Network/Provider Relations. Support the implementation of new processes and workflows for provider data maintenance.

Quality

Integrate health literacy principles into all communication including Members and Providers. Support strategies that meet clinical, quality and network improvement goals. Promote the use of Health Information Technology to support and monitor the effectiveness of health and social interventions and make data-driven recommendations as needed. For staff in clinical roles, foster collaborative relationships with members and/or providers to promote and support evidence-based practices and care coordination. Perform regular audits of provider data to identify and resolve discrepancies or inaccuracies.

Regulatory

Ensures work is carried out in compliance with regulatory and/or accreditation standards as well as contractual requirements. Assist with provider onboarding and credentialing processes, ensuring compliance with health plan policies. Collaborate with internal and external stakeholders to validate and maintain provider records in alignment with organizational policies and regulatory requirements. Generate and validate reports, including fall out reports for regulatory files such as Medicaid provider files and the MPF, ensuring compliance with state and federal guidelines. Professional Accountability Promotes and supports a culturally welcoming and inclusive work environment. Acts with the highest integrity and ethical standards while adhering to Parkland's Mission, Vision, and Values. Adheres to organizational policies, procedures, and guidelines. Completes assigned training, self-appraisal, and annual health requirements timely. Adheres to hybrid work schedule requirements. Attends required meetings and town halls. Recognizes and communicates ethical and legal concerns through the established channels of communication. Demonstrates accountability and responsibility by independently completing work, including projects and assignments on time, and providing timely responses to requests for information. Maintains confidentiality at all times. Performs other work as requested that is reasonably related to the employee’s position, qualifications, and competencies.

 

Job Accountabilities

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. As part of our commitment to our patients and employees’ wellness, Parkland Health is a tobacco and smoke-free campus.