Provider Data Integrity Analys

We are searching for a Provider Data Integrity Analyst -- someone who works well in a fast-paced setting. In 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.

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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 Plan’s 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, CRM’s, 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 Bachelor's Degree
•    4 years Combined managed care contracting, provider reimbursement and analysis, strategic planning and/or project management experience
 

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