Provider Data Analyst - 26-54

Job Description

The Provider Data Analyst supports processes, standards, and other daily provider data operations in the system of record (SOR) Salesforce. They work closely with health plans and internal partners to ensure provider data is accurately reflected in health plan systems and directories, and internal downstream systems as requested.

The Analyst creates reports and dashboards to monitor provider data quality and operational performance. The role leverages approved AI-enabled capabilities to support day-to-day responsibilities and improve efficiency and the integrity of provider data.

ESSENTIAL RESPONSIBILITIES

• Provider Data Management Lifecycle:
  • Enter, update, and maintain complete and accurate provider demographic, billing, and 30 contract data (adds/changes/terminations) across systems.
  • Ensure provider data is updated in accordance with compliance requirements, processing rules, and guidelines; meet department SLAs and required timelines.
  • Track, document, and resolve provider data requests and inquiries through completion; investigate issues, validate corrections, and provide status updates and routine data extracts/reports as needed.
  • Create, maintain, and distribute provider rosters (including outreach lists) to validate required information and ensure accuracy, completeness, and timeliness.
  • Support internal/external audits and compliance activities (including CA SB 137 quarterly audits) by gathering documentation, completing assigned analysis, and responding to requests within established timelines.
  • Create and route provider change request forms and manage provider portal accounts, as assigned.
  • Support system enhancements by helping document requirements, executing test cases, and validating results to strengthen data accuracy and controls.
• Data Quality and Optimization:
  • Support data cleanup and remediation initiatives; assist with meeting coordination, action tracking, and status updates.
  • Absorb root-cause, gap, and trend analyses for provider data issues; document findings and share recommendations with the team.
  • Maintain working knowledge of provider data sources and end-to-end data flows, including downstream reporting impacts.
  • Identify automation opportunities; help define business requirements and validate implemented workflows.
  • Use approved AI and automation tools to help streamline data management tasks (e.g., intake triage, validation, deduplication, reconciliation, and exception handling) and track basic metrics that demonstrate efficiency gains.
  • Create ad hoc provider roster reports and quality assurance dashboards to support data validation, monitoring, and operational decision-making.
• Health Plan & Stakeholder Support:
  • Support health plans and external partners regarding provider data, including directory accuracy, routine issue resolution, and audit support, escalating as needed.
  • Ensure health plan provider databases and provider directories accurately reflect current provider information by coordinating updates, validations, and reconciliations across systems.
  • Provide responsive support for provider data and system-related inquiries; follow troubleshooting steps, communicate status, and escalate issues to the appropriate teams and vendors.
  • Log, track, and escalate issues as needed; communicate progress and outcomes through closure to meet time-sensitive needs.
  • Create and maintain team documentation and training materials to support consistent processes and knowledge sharing.
  • Support health plan, regulatory, and internal audits by researching items, documenting outcomes, and assisting with corrective action follow-up.
  • Aid in provider data discrepancies escalated by practices and partner teams by researching the issue, coordinating corrections, and confirming updates are reflected in downstream systems and deliverables.
• General/Other Duties:
  • Support provider data projects as assigned.
  • Perform other related duties as assigned.

SKILLS AND EXPERIENCE REQUIRED

• Bachelor’s degree required or equivalent experience.
• Experience supporting or coordinating projects (e.g., tracking tasks, documenting decisions, communicating status).
• Profound data analysis skills, including data validation, trend analysis, and root-cause investigation.
• Proactive, solutions-oriented approach and comfort adapting to new systems, processes, and regulations.
• Ability to prioritize and manage multiple deadlines; strong follow-through and comfort working independently and in a team environment.
• Ability to recognize when to ask questions and escalate issues appropriately to meet time-sensitive needs.
• Excellent written and verbal communication skills; able to communicate effectively with cross-functional partners.
• Demonstrated ability to work accurately under deadlines while balancing competing priorities.
• Proficient in Microsoft Office Suite.

PREFERRED EXPERIENCE

• Intermediate Microsoft Excel skills (formulas, filters, pivot tables, and basic reconciliations); ability to work with large datasets.
• Experience with reporting/visualization tools (e.g., Tableau) preferred.
• Experience using approved AI tools to support data quality and operational workflows.