Provider Database Analyst

$83,243 - $124,864/Yr

Santa Clara Family Health Plan - San Jose, CA

Full-time - Mid Level

San Jose, CA

About the position

The Provider Database Analyst at Santa Clara Family Health Plan serves as the subject matter expert for all systems related to the provider network. This role focuses on transforming data into actionable information to support decision-making and operational processes. The analyst will utilize their analytical skills to interpret system functionalities, reporting requirements, and operational needs while ensuring compliance with regulatory standards and internal policies.

Responsibilities

• Maintain knowledge of SCFHP provider network structure and apply it to manage information in core systems.
• Research and interpret regulatory guidelines to guide decision-making.
• Collaborate with IT to communicate systems requirements for Provider Network Operations.
• Act as a subject matter expert on data integration and system upgrades.
• Analyze operational data processes and document procedures to support operations.
• Produce accurate provider lists for print directories and maintain quality standards.
• Document policies and workflows related to departmental systems and data.
• Train staff on policies and procedures to ensure compliance.
• Oversee data entry activities and ensure accuracy using SQL validation reports.
• Serve as the primary contact for software vendors related to Provider Network Operations.
• Use analytical skills to review data for contracting strategies.

Requirements

• Bachelor's Degree in Computer Science, Business, Health Administration, or related field.
• Minimum three years of experience in a managed care environment with a focus on provider database management.
• Experience with MS SQL Business Intelligence tools for database reporting.
• Two years' experience with database concepts and data processes.
• General knowledge of provider contracts and reimbursement methodologies.
• Project management skills to support multiple projects.
• Strong problem-solving skills and ability to think creatively in a fast-paced environment.
• Proficient in Microsoft Office applications including Outlook, Word, Excel, and PowerPoint.
• Excellent communication skills for interaction with internal departments and external entities.
• Ability to prioritize tasks and work effectively under pressure.
• Ability to maintain confidentiality and comply with company policies.