Provider Data Integrity Analys

About the role

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.

Responsibilities

• 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
• 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
• 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
• 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

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

About Us

Founded in 1996, Texas Children’s Health Plan is the nation's first health maintenance organization (HMO) created just for children. We provide STAR/Medicaid and Children's Health Insurance Program (CHIP) to pregnant women, teens, children and adults in Houston and surrounding areas.

Currently, the Health Plan has more than 375,000 members who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. Texas Children's Health Plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area.