Provider Data Analyst II
Provider Data Analyst II
Posted on :
05-04-2025
Employer Active
1 Vacancy
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Job Description
About Moda
Founded in Oregon in 1955 Moda is proud to be a company of real people committed to quality. Today like then were focused on building a better future for healthcare. That starts by offering outstanding coverage to our members compassionate support to our community and comprehensive benefits to our employees. It keeps going by connecting with neighbors to create healthy spaces and places together. Moda values diversity and inclusion in our workplace. We aim to demonstrate our commitment to diversity through all our business practices and invite applications from candidates that share our commitment to this diversity. Our diverse experiences and perspectives help us become a stronger organization. Lets be better together.
Job Summary:
Provider Data Analysts conduct analysis to support contract negotiations with medical providers. The analyst uses claims data as well as other data sources to model the impact of various contract terms. Functions include the use of analytic tools to pull data from Modas data warehouse analysis that converts the raw data into useful information and analytic summaries that communicate the information to the departments customers. This is a FT WFH role.
Pay Range
$61877 $77364 annually (depending on experience).
*Actual pay is based on qualifications. Applicants who do not exceed the minimum qualifications will only be eligible for the low end of the pay range.
Please fill out an application on our company page linked below to be considered for this position.
Dental Vision Pharmacy Life & Disability
Primary Functions:
- Under general supervision provide analysis and recommendations in support of Professional Relations contracting efforts
- Develop tools to model contract terms and the impact of moving a provider to new contract terms
- Develop standard reports as defined by Professional Relations to manage provider networks. Work closely with Professional Relations to define these reports
- Prepare special requests made from various areas for providers information
- Assist in the development and implementation of provider scorecards provider profiles and other tools to help manage medical provider networks
- Assist in the development of provider metrics to support consumerdriven healthcare initiatives
- Provide input on data elements that should be made available and reviewed for quality in support of provider analysis
- Create and maintain documentation of the processes developed for provider analysis
- Audit contract terms using Facets configuration files; research and analyze healthcare claims to determine if contract terms were configured correctly
- Act as an internal consultant to the provider contracting team providing advice on fee schedules impacts and potential outcomes of various contract terms healthcare industry trends and other information providing written or verbal presentation of information as needed
- May provide peer review guidance or expertise to less experienced analysts
Required Skills & Experience:
- Bachelors degree required; masters in healthcare administration or business administration is preferred
- Three to five years of experience in the health insurance healthcare provider or public health industry
- Strong statistical analytical and problemsolving skills
- Experience with data analysis tools such as SAS SQL decision support systems business intelligence tools and/or Microsoft Access
- Experience with healthcare billing or claims data
- Knowledge of reimbursement concepts and methodologies financial analysis contracting and contract negotiations
- Advanced Microsoft Excel skills and proficiency with all Microsoft Office products
- Strong verbal written and interpersonal communication skills with the ability to tailor the type and level of communication to the intended audience
- Must be able to work independently on complex projects and be flexible to changes in priorities and changing workload
- Strong ability to work collaboratively as part of a team
- Maintain confidentiality and project a professional business image
Contact with Others & Working Conditions:
- Extensive computer and keyboard work. Fluctuating workflow with deadlines that may require work in excess of 37.5 hours.
- Internally primarily with the provider contracting team occasionally with Moda actuaries and other departments
Together we can be more. We can be better.
Moda Health seeks to allow equal employment opportunities for all qualified persons without regard to race religion color age sex sexual orientation national origin marital status disability veteran status or any other status protected by law. This is applicable to all terms and conditions of employment including recruiting hiring placement promotion termination layoff recall transfer leaves of absences compensation and training.
For more information regarding accommodations please direct your questions to Kristy Nehler & Danielle Baker via email.
Required Experience:
IC
Employment Type
Full-Time
Key Skills
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