JOB SUMMARY:
The Associate Provider Network Analyst plays a critical role in supporting cross-departmental communication and collaboration through data analysis and reporting. This role focuses on leveraging analytics to facilitate the efficient management of network expansion and audit activities, ensuring that network adequacy and regulatory compliance are maintained across multiple states.
ESSENTIAL JOB DUTIES:
To perform this job, an individual must accomplish each essential function satisfactorily, with or without a reasonable accommodation.
Provider Network Analysis and Tools Maintenance:
- Data Interpretation and Reporting: Conduct weekly Network Analysis Reports using the J2 Health Network Adequacy Solutions Tool to assess and ensure network adequacy. Analyze and interpret large datasets, and create visual reports to effectively communicate findings.
- Impact Analysis: Perform detailed impact analysis on existing and potential networks when providers are added or removed, identifying potential gaps and areas for improvement.
- Tool and Report Maintenance: Ensure the consistent and timely updating of key tools and reports, such as the Red Light Green Light Master Dashboard and the States Comparison Summary, using J2 Health and Excel. Maintain data accuracy, especially during peak periods.
- Continuous Improvement: Assist in developing and refining additional analytical tools and resources to support Network Development, Provider Relations, and other cross-functional teams. Regularly review and optimize existing tools and processes to enhance efficiency and accuracy in network reporting
Provider Network Analyst Mailbox and Contract Rerouting:
- Monitor and manage the Provider Network Analyst Mailbox, ensuring all incoming requests are promptly addressed, either by resolving them directly or escalating to appropriate team members.
- Contract Rerouting: Act as the primary point of contact for the contract rerouting process, specifically for Fee-For-Service (FFS) Letters of Agreement (LOAs). Review all incoming FFS LOAs and manage their routing according to established Standard Operating Procedures (SOPs).
- Maintain clear communication and documentation throughout the contract rerouting process, ensuring compliance with internal guidelines and regulatory requirements
SOP Reviews/Creation, Process Workflows, and Job Aids:
- Assist the Provider Network Analyst and Director of Plan Network Operations to evaluate, create, and refine Standard Operating Procedures (SOPs) that support cross-functional departmental integration and ensure compliance with CMS standards.
- Assist in developing and improving process workflows and job aids to streamline operations, enhance productivity, and support consistent application of best practices across departments.
- Regularly review and update SOPs and workflows to adapt to evolving regulatory requirements and organizational needs.
Collaboration and Communication:
- Work closely with the Provider Network Analyst and Director of Plan Network Operations to ensure alignment with network expansion and audit objectives, facilitating smooth execution of initiatives.
- Collaborate with various departments, including Network Development, Provider Relations, and Executive Leadership, to gather and analyze data, fulfill reporting requirements, and support strategic decision-making.
- Participate in cross-functional meetings, providing insights and recommendations based on network analysis, and contribute to the continuous improvement of network management processes.
QUALIFICATIONS:
- Education: Bachelor's degree in a relevant field or 2 years of equivalent professional experience.
- Technical Skills: Proficiency in data analytics and Microsoft Suite, particularly advanced Excel, Access, Word, Adobe Acrobat, and PowerPoint.
- Communication: Strong communication and collaboration skills.
- Self-Motivation: Ability to work independently and manage time effectively under tight deadlines.
- Attention to Detail: Strong focus on accuracy and detail.
- Analytical Skills: Ability to analyze complex data and solve challenges.
PREFERRED QUALIFICATIONS:
- Experience in Provider Data Analytics, Provider Relations, Network Development, or Contract Review.
- Familiarity with Medicare Advantage, including CMS MA ISNP Program and CMS regulatory requirements.
- Knowledge of Provider Network Adequacy Review, conducting process audits, and developing SOPs, workflows, and job aids.
- Proficiency with Network Adequacy Solution Tools.
EQUAL OPPORTUNITY EMPLOYER
This Organization is an equal opportunity employer. We do not discriminate based on race, color, religion, sex, handicap, disability, age, marital status, sexual orientation, national origin, veteran status, or any other characteristic(s) protected by federal, state, and local laws. This Organization will make reasonable accommodations for qualified individuals with disabilities should a request for accommodation be made. A key part of this policy is to provide equal employment opportunity regarding all terms and conditions of employment and in all aspects of a person's relationship with this Organization including recruitment, hiring, promotions, upgrading positions, conditions of employment, compensation, training, benefits, transfers, discipline, and termination of employment.