Lead Analyst Provider Data Management
Lead Analyst Provider Data Management
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Job Description
Your Future Evolves Here
Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered.Our pursuit of this mission is the driving force that brings us to work each day. We believe in embracing new ideas challenging ourselves and failing forward. We respect and celebrate individual talents and team wins. We have fun while working hard and Evolenteers often make a differenceworkingin everything from scrubs to jeans.
Are we growing Absolutely and Globally. In 2021 we grew our teams by almost 50 and continue to grow even more in 2022.Are we recognized as a company you are supported by for your career and growth and a great place to workDefinitely. Evolent Health International (Pune India) has been certified as Great Places to Work in 2021. In 2020 and 2021 Evolent in the U.S. was both named Best Company for Women to Advance list by Parity and earned a perfect score on the Human Rights Campaign (HRC) Foundations Corporate Equality Index (CEI). This index is the nations foremost benchmarking survey and report measuring corporate policies and practices related to LGBTQ workplace equality.
We recognize employees that live our values give back to our communities each year and are champions for bringing our whole selves to work each day. If youre looking for a place where your work can be personally and professionally rewarding dont just join a company with a mission. Join a mission with a company behind it.
What Youll Be Doing:
Job Description
Evolent Health is looking for a Provider Data Specialist to be a key member of the PDM Operations team. Reporting to the Supervisor of Provider Data Management this individual will play a critical role in executing Evolent Healths mission by working directly with our partners focused on coordinating monitoring trending and supporting report requirements of business operational and clinical programs within Provider Network Management. This Provider Data Analyst will work with both internal and external business partners to implement ongoing operational monitoring resolve service barriers develop solutions to improve effectiveness and identify continuous improvement initiatives to increase service levels.
Essential functions
Serve as a liaison between the internal team members and partner organization providing support for provider data enrollment activities; acts as liaison with technology team and business product team members.
Oversee and mentor a team of data analysts providing guidance feedback and support to enhance their performance.
Defines analysis methodology and provides analytic support.
Analyzes existing systems to recommend enhancements and creates new systems to reduce manual processes and maximize the business efficiencies.
Analyzes data from conceptualization through presentation and requires proficiency with analytical tools knowledge of data analysis methodology use of presentation software and strong communication skills.
Evaluate and recommend data tools software and platforms to improve analysis capabilities.
Identifies evaluates and implements new datadriven strategies and processes for the department
Develops tools and reports that lend valuable insights that capitalize on a combination of internal and external data.
Recommends enhancements to existing systems in accordance to business needs by creating ad hoc and standard reports as well as information delivery technologies.
Prepare reports in an accurate concise and timely fashion.
Provide guidance and support to all claims and operations personnel towards resolution of provider data and claims problems with an emphasis on root cause analysis and resolution of problems
Compile review and analyze management reports and take appropriate action
Identify and advise Claims Provider Network Management Medicare Operations and other operational areas of trends problems and issues as well as recommended course of action; ensure timely communication; participate in the development and implementation of solutions
Monitor adherence to the efficiency and service level goals including volume processing timeliness accuracy and other metrics.
Develop deep understanding of processing capabilities and limitations of claims and benefits with TPA/BPO systems tools and resources; provide recommendations to meet plan requirements
Create and report operational tracking metrics and dashboards for monitoring claims provider disputes and benefits performance.
Support internal plan team members with the resolution of daily issues.
Work with other departments to identify and resolve problems leading to incorrect provider data and issues regarding payment of claims.
Serve on various committees and attends required meetings.
Key competencies/skill/success factors:
Experience working within a health plan managed care organization provider operated healthcare environment or third party administrator
Good Knowledge on Python SQL Server SSMS SSRS.
Extensive knowledge of PCs and related software applications such as Word PowerPoint Excel Project
Demonstrated exceptional active listening and communication skills
Experience in systems and languages related to database lifecycle management such as MS Access Visual Basic etc
Qualification and Experience:
Required
Associates Degree or equivalent
7 years of experience in collecting analyzing and presenting data and recommendations to management
Big plus
Bachelors degree in Computer Science Statistics Mathematics or related field
4 5 years data analysis and business intelligence experience working with BI suites such as Power BI SSRS or other enterprise class tools
Mandatory Requirements:
Employees must have a highspeed broadband internet connection with a minimum speed of50 Mbpsand the ability to set up a wired connection to their home network to ensure effective remote work. These requirements may be updated as needed by the business.
Evolent Health is an equal opportunity employer and considers all qualified applicants equally without regard to race color religion sex sexual orientation gender identity national origin veteran status or disability status.
Required Experience:
IC
Employment Type
Full-Time
