Sign upLog in

Provider Network Data Adequacy Analyst

Cambia Health Solutions

Burlington, WA

Apply
JOB DETAILS
JOB TYPE
Full-time, Employee
SKILLS
Analysis Skills, Artificial Intelligence (AI), Communication Skills, Computer Networks, Content Management Systems (CMS), Contract Analysis, Contract Negotiation, Corrective Action, Customer Support/Service, Data Analysis, Gap Analysis, Health Economics, Health Plan, Healthcare, Healthcare Administration, Healthcare Providers, Maintain Compliance, Medicare, Microsoft Access Database, Microsoft Office, Multitasking, Network Architecture/Engineering, Network Performance/Analysis, Oracle Database, Organizational Skills, Policy Development, Presentation/Verbal Skills, Procedure Development, Project/Program Management, Provider Contracting, Quest Software TOAD, Regulations, Regulatory Compliance, Regulatory Submissions, Systems Maintenance, Time Management, Writing Skills
ADDITIONAL COMPENSATION
0
LOCATION
Burlington, WA
POSTED
30+ days ago
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, Cambia's 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 recommendations? Then this role may be the perfect fit.

What You Bring to Cambia:

Qualifications:

Network Adequacy & Access Analyst would have a bachelor's 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 $92,700 - $103

About the Company

C

Cambia Health Solutions

Resume Resources

Free Resume TemplatesFree Resume Builder