Associate Provider Network Data Analyst (Remote in TN)

American Health Plans - Portland, OR

Full-time

Remote - Portland, OR

Securities, Commodity Contracts, and Other Financial Investments and Related Activities

About the position

The Associate Provider Network Data Analyst plays a critical role in supporting cross-departmental communication and collaboration through data analysis and reporting. This position 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.

Responsibilities

• 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.
• Perform detailed impact analysis on existing and potential networks when providers are added or removed, identifying potential gaps and areas for improvement.
• 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.
• 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.
• Monitor and manage the Provider Network Analyst Mailbox, ensuring all incoming requests are promptly addressed.
• 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.
• Assist in evaluating, creating, and refining Standard Operating Procedures (SOPs) that support cross-functional departmental integration and ensure compliance with CMS standards.
• Develop and improve 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.
• Work closely with the Provider Network Analyst and Director of Plan Network Operations to ensure alignment with network expansion and audit objectives.
• Collaborate with various departments 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.

Requirements

• Bachelor's degree in a relevant field or 2 years of equivalent professional experience.
• Proficiency in data analytics and Microsoft Suite, particularly advanced Excel, Access, Word, Adobe Acrobat, and PowerPoint.
• Strong communication and collaboration skills.
• Ability to work independently and manage time effectively under tight deadlines.
• Strong focus on accuracy and detail.
• Ability to analyze complex data and solve challenges.

Nice-to-haves

• 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.