Provider Network Data Adequacy Analyst

Provider Network Data Adequacy Analyst

Hybrid opportunity in Portland OR; Medford OR; Lewiston ID; Boise ID; Renton WA; Burlington WA; Vancouver WA; Spokane WA; Salt Lake City ID

Build a career with purpose. Join our Cause to create a person-focused and economically sustainable health care system.

Who We Are Looking For:

Every day Cambias dedicated team of Provider Network Data Adequacy Analyst are living our mission to make health care easier and lives better. As a member of the Network Innovations and Analytics team our Provider Network Data Adequacy Analyst produces and analyzes provider network adequacy reports to assess healthcare access. They provide data-driven recommendations to Network VPs on network modifications that improve member access and deliver greater value all in service of making our members health journeys easier.

Do you have a passion for data analysis and improving healthcare access Do you thrive in a role that combines analytical expertise with strategic recommendationsThen this role may be the perfect fit.

What You Bring to Cambia:

Qualifications:

Network Adequacy & Access Analyst would have a bachelors degree in Business Health Care Administration Data Analysis or related field and 5 years of related experience or equivalent combination of education and experience.

Skills and Attributes:

• Experience in health plan/payor environment with provider data network development and network analysis

• Proficiency in database query tools and methodology (SQL Oracle Greenplum Toad MS Access)

• Strong organizational skills to manage multiple projects simultaneously and meet deadlines

• Ability to derive insights from data regarding network access and provider value of care by specialty

• Self-directed work style with flexibility to coordinate complex rapidly changing activities

• Proficient in MS Office with aptitude for learning new corporate software

• Proven project management and analytical capabilities with minimal supervision required

• Excellent written and oral communication skills; experience with AI tools highly desired

What You Will Do at Cambia:

• Responsible for ensuring Cambia is meeting network adequacy requirements for Medicare Advantage and Qualified Health Plan networks as well as local regulatory network adequacy requirements across a broad range of specialties and geographies.

• Conducts regulatory filings and submission of required reporting for provider network adequacy and access to maintain compliance with state federal and CMS requirements and resolves all questions issues and objections related to such filings such as Medicare HSD tables.

• Responsible for analysis of access gaps and opportunities by provider specialty and consolidating data for the purpose of recommending network changes.

• Responsible for assessing provider networks using efficiency and effectiveness data for the purpose of network architecture.

• Provides analytical support and supports internal customers with network assessments and corrective actions to address network deficiencies and opportunities.

• Evaluate existing network adequacy policies and procedures including verification of compliance standards lead implementation of recommended updates and development of new policies and procedures.

• Performs regular network adequacy evaluations to support provider contract negotiations provider terminations and provider network optimization.

• Produce summaries that interpret network adequacy and access report outcomes and findings and suggest strategies and recommendations for improvement to contracting teams.

The expected hiring range for the Provider Network Data Adequacy Analyst is $92700 - $103600 depending on skills experience education and training; relevant licensure / certifications; and performance history. The bonus target for this position is 15% target. The current full salary range for this role is $87000 - $142000.#LI-hybrid

About Cambia

Working at Cambia means being part of a purpose-driven award-winning culture built on trust and innovation anchored in our 100 year history. Our caring and supportive colleagues are some of the best and brightest in the industry innovating together toward sustainable person-focused health care. Whether were helping members lending a hand to a colleague or volunteering in our communities our compassion empathy and team spirit always shine through.

Why Join the Cambia Team

At Cambia you can:

• Work alongside diverse teams building cutting-edge solutions to transform health care.
• Earn a competitive salary and enjoy generous benefits while doing work that changes lives.
• Grow your career with a company committed to helping you succeed.
• Give back to your community by participating in Cambia-supported outreach programs.
• Connect with colleagues who share similar interests and backgrounds through our employee resource groups.

We believe a career at Cambia is more than just a paycheck and your compensation should be too. Our compensation package includes competitive base pay as well as a market-leading 401(k) with a significant company match bonus opportunities and more.

In exchange for helping members live healthy lives we offer benefits that empower you to do the same. Just a few highlights include:

• Medical dental and vision coverage for employees and their eligible family members including mental health benefits.
• Annual employer contribution to a health savings account.
• Generous paid time off varying by role and tenure in addition to 10 company-paid holidays.
• Market-leading retirement plan including a company match on employee 401(k) contributions with a potential discretionary contribution based on company performance (no vesting period).
• Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service with Cambia immediately preceding leave).
• Award-winning wellness programs that reward you for participation.
• Employee Assistance Fund for those in need.
• Commute and parking benefits.

Learn more about our benefits.

We are happy to offer work from home options for most of our roles. To take advantage of this flexible option we require employees to have a wired internet connection that is not satellite or cellular and internet service with a minimum upload speed of 5Mb and a minimum download speed of 10 Mb.