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Health Care & Hospital Operations

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Analyst, Provider Data Management

Location: Atlanta, GA Additional Locations:
Job Number: 774751 Date posted: 02/20/2019
Description:

Supports department goals by maintaining all network provider data received from business units. Conducts audits and analysis in accordance with provider contracts, claims, and regulatory requirements while using experience with data extracts, manipulation and/or data management.  Designs, coordinates, and produces reporting required for internal and external stakeholders and regulatory agencies. Provides recommendations on process or system improvements, communicates with key stakeholders with regard to research requests and general inquiries.  


Essential Responsibilities:

  • Maintains provider systems with accurate and up-to-date information for external/affiliated providers while displaying analytical and problem-solving ability. Conducts audits and analysis in accordance with provider contracts, claims, and regulatory requirements while using experience with data extracts, manipulation and/or data management.
  • Creates, researches and sends ad hoc and monthly reports to business partners including but not limited to, network adequacy, provider directory, provider participation and marketplace.
  • Performs intermediate spreadsheet analyses and database solutions using tools such as Cactus and Excel; develops scorecard reporting and provides basic statistical measurement interpretation.
  • Researches and responds to inquiries from business units and stakeholders.
  • Performs other duties as assigned.

  • Basic Qualifications:

    Experience

  • Minimum four (4) years of provider contracting, provider data and health care operations experience which includes data analyses.
  • Minimum four (4) years of healthcare claims experience in regards to how provider data affects payments/processing and regulatory agency audits.
    Education


  • Bachelor's degree in business, health care or related field or four (4) years of experience in a directly related field.
  • High School Diploma or General Education Development (GED) required.
    License, Certification, Registration

  • N/A.

    Additional Requirements:

  • Strong proficiency in Microsoft Office applications.
  • Strong analytical and problem-solving skills.
  • Motivated to acquire new skills and knowledge for improved performance while working under pressure.
  • Strong work ethic and completes tasks in a timely and efficient manner.
  • Effective and clear communication using appropriate channels to maintain working relationships.
  • Strong ability to meet aggressive deadlines.
  • Understanding of health plan products such as HMO, PPO, Medicare, etc.
  • Progressive experience with data extracts, manipulation and/or data management.

    Preferred Qualifications:

  • Extensive experience in provider data management and system analysis.
  • Primary Location: Georgia,Atlanta,Regional Office - 10 Piedmont 10 Piedmont Center Scheduled Weekly Hours: 40 Shift: Day Workdays: Mon, Tue, Wed, Thu, Fri Working Hours Start: 8:00 AM Working Hours End: 5:00 PM Job Schedule: Full-time Job Type: Standard Employee Status: Regular Employee Group/Union Affiliation: Salaried, Non-Union, Exempt Job Level: Individual Contributor Job Category: Healthcare / Hospital Operations Department: Provider Contracting & Network Management Travel: No Kaiser Permanente is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, sexual orientation, national origin, marital status, parental status, ancestry, disability, gender identity, veteran status, genetic information, other distinguishing characteristics of diversity and inclusion, or any other protected status.

    External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with federal and state laws, as well as applicable local ordinances, including but not limited to the San Francisco and Los Angeles Fair Chance Ordinances.

    About Health Care & Hospital Operations Careers

    Health Care & Hospital Operations Careers

    Envision the future, inspire change, and deliver results. Put your talents to work not just at a powerful business, but at an organization dedicated to empowering the health and well-being of millions. As a valued member of the Kaiser Permanente team, your visionary and strategic contributions are especially vital to our success. Come drive change within the organization and across the future of health care.

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