Job Summary

The Provider Network Analyst Senior is responsible for research and analysis related to provider network issues. ;The incumbent will support new business provider recruitment and contracting and/or conduct research and analysis related to provider claims issues.

Responsibilities

Key responsibilities:
• Identifies systematic and procedural issues resulting in processing reports and initiating actions to produce reports.
• Extract, manipulate and evaluate accuracy of provider data for new implementations.
• Responsible for ensuring plan remain in compliance with provider contracts.
• Gathers complex statistical data analysis to identify financial and non-financial impacts, process and system improvements.
• Use provider contract maintenance software to create provider contract templates and create files associated with contract templates and other credentialing forms.
• Assist and coordinates configuration and testing to generate new reports as required.
Configuration Management Responsibilities include, but are not limited to:
• Analyzes and interpret data to determine appropriate configuration changes using in depth expertise in data analysis and data mining. ;
• State benefits/policies, provider contracts, business requirements and converting these terms to configuration parameters.
• Accurately interprets, updates and maintains benefit plans, provider contracts, fee schedules and various system tables through for the purpose of triaging production issues and developing business requirements for new configuration.
• Demonstrates previous experience and knowledge to research and resolve claim/encounter issues, pended claims and update system(s) as necessary.
• Works with fluctuating volumes of work and can prioritize work to meet deadlines and needs of user community.

Knowledge, Skills & Abilities

Patient Group Knowledge (Only applies to positions with direct patient contact)

The employee must possess/obtain (by the end of the orientation period) and demonstrate the knowledge and skills necessary to provide developmentally appropriate assessment, treatment or care as defined by the department’s identified patient ages. Specifically the employee must be able to demonstrate competency in: 1) ability to obtain and interpret information in terms of patient needs; 2) knowledge of growth and development; and 3) understanding of the range of treatment needed by the patients.

Competency Statement

Must demonstrate competency through an initial orientation and ongoing competency validation to independently perform tasks and additional duties as specified in the job description and the unit/department specific competency checklist.

Common Duties and Responsibilities
(Essential duties common to all positions)

1. Maintain and document all applicable required education.
2. Demonstrate positive customer service and co-worker relations.
3. Comply with the company's attendance policy.
4. Participate in the continuous, quality improvement activities of the department and institution.
5. Perform work in a cost effective manner.
6. Perform work in accordance with all departmental pay practices and scheduling policies, including but not limited to, overtime, various shift work, and on-call situations.
7. Perform work in alignment with the overall mission and strategic plan of the organization.
8. Follow organizational and departmental policies and procedures, as applicable.
9. Perform related duties as assigned.

Education 

• Bachelor's Degree (Required) 

Education: Bachelor's degree in business or an equivalent education 

Experience: 1-2 years managed care or related experience

Credentials 

• No Certification, Competency or License Required

Work Schedule: Days

Status:  Full Time Regular 1.0

Location: Northgate-400 Association Dr.

Location of Job: US:WV:Charleston

Talent Acquisition Specialist: Tamara B. Young tammy.young@vandaliahealth.org