Provider Data Integrity Analys

We are searching for a Provider Data Integrity Analyst -- someone who works well in a fast-paced this position you will be responsible for the monthly audits and reconciliation of all Provider data within multiple systems within the Health Plan. To ensure that the Health Plan data is aligned with the States and that all Provider updates including but not limited to adds terms and changes are being made timely and accurately into our Core systems. Monitor the reporting of Provider data to support the Provider Relations teams ensuring clean accurate and timely data related to State regulations.

Think youve got what it takes

Job Duties & Responsibilities
Data management and analytics
Analyze reports and data sets for anomalies within the Provider data from multiple sources within the Health Plan
Identify and update data discrepancies between the State requirements and the Health Plans data
Coordinate and collaborate with Vendors Providers and other departments within the Organization to ensure that all systems are reconciled
Propose solutions to Business Partners for data integrity issues identified during your analysis
Always maintain data standards in alignment with the State and other Regulatory requirements
Manage data discrepancies and maintenance functions in an efficient secure timely manner with attention to all defined technical processes and use protocols
Technical accuracy of provider data integrity
Create and maintain policy and procedures for reconciliation and audit protocols of Provider data
Develop and document Business rules to support an external audit of our Provider data
Review updates from the State pertaining to Provider data to ensure that we remain Compliant.
Drive system and or process changes to certify that all State requirements are met
Evaluate the Health Plan practices for performing this function and recommend any changes that are necessary to support data integrity
Evaluate datasets for consistency completeness accuracy and reasonableness
Support TCHP Provider Data Integrity initiatives
Generate data reports on periodic basis as requested or needed for the data management process
Identify and correct data deficiencies within the Health Plan Systems
Collaborate with our Provider Directory Vendor ensuring accurate and timely data
Record and document as required data management activities including but not limited to service forms CRMs and the Master Provider File
Review and analyze the P files between the State and the Health Plan
Recommend and implement process improvement identified as needed by the Health Plan to support the continued integrity of the Provider data
Data integrity liaison between TCHP departments
Address any issues questions and problems in accurate and timely manner
Self-solve issues if provider data integrity is in question
Educate other departments on data use and Business rule

Skills & Requirements
Required H.S. Diploma or GED and a preferred Bachelors Degree
4 years Combined managed care contracting provider reimbursement and analysis strategic planning and/or project management experience