Senior Provider Network Analyst

Responsibilities

• Analyze provider data to identify trends, discrepancies, and process improvement opportunities
• Extract, validate, and maintain accurate provider data to support new implementations and ongoing operations
• Ensure compliance with provider contracts, state requirements, and internal policies
• Interpret provider contracts, state policies, and business requirements, and translate them into system configuration
• Maintain and update benefit plans, provider contracts, fee schedules, and system tables
• Perform quantitative and qualitative analysis to evaluate financial and operational impacts
• Conduct data mining and impact analysis to support configuration decisions and issue resolution
• Create, maintain, and enhance reports to support business decision-making
• Utilize contract maintenance systems to build templates and manage documentation (e.g., contracts, credentialing forms)
• Support configuration activities, including testing, validation, and implementation of system changes
• Research and resolve claims, encounter, and provider data issues, including pending claims
• Assist with root cause analysis and provide recommendations for issue resolution
• Collaborate with cross-functional teams to address production issues and support system enhancements
• Manage multiple priorities and adapt to changing workload demands

Requirements

• Bachelor’s degree in business, healthcare, or a related field, or equivalent experience
• 1 to 3 years of healthcare or managed care experience
• 3 to 5 years of analytical experience in a healthcare environment
• Experience with provider data, claims processing, or network operations preferred
• Knowledge of Facets or similar configuration platforms preferred
• Experience with SQL, MS Access, or other data/query tools preferred
• Proficiency in Microsoft Office Suite (Excel, Word, PowerPoint), with advanced Excel skills strongly preferred and Power BI
• Experience with report development, data analysis, and database management

Skills

• Strong analytical and problem-solving skills, with the ability to interpret complex data and make actionable recommendations
• Strong attention to detail with a focus on accuracy and data integrity
• Effective organizational and time management skills
• Strong written and verbal communication skills, including the ability to present findings clearly
• Ability to collaborate across teams and build effective working relationships
• Working knowledge of healthcare coding sets, claims processes, and regulatory requirements