Provider Data Analyst

At HCSC, we consider our employees the cornerstone of our business and the foundation to our success. We enable employees to craft their career with curated development plans that set their learning path to a rewarding and fulfilling career.

Come join us and be part of a purpose driven company who is invested in your future!

Job Summary

This Position Is Responsible For Provider Data Accuracy / Data Quality Improvement In Resolution Of Provider Demographic Issues And Working With Internal Departments To Evaluate And Resolve Provider/Demographic Issues That Impact The Contract Or Service Conduct Research And Identify Issues, Develop Reports And Lead The Creation Of Reporting Needs.

JOB RESPONSIBILITIES:

1. Responsible for the coordination and resolution of “systemic” problems. Identify problems and research the impact and origin for resolution. Report problems to management and coordinate with either internal staff or the provider to assure resolution.
2. Assist with review of provider directories for the managed care networks.
3. Develop and maintain working relationship with internal departments. Coordinate with departments as required on provider data accuracy projects.
4. Communicate with key facilities, physician groups, managers, IPAs, PHOs and other essential contacts, through phone or correspondence.
5. Process provider change forms. Maintain tickler system and verify changes have been made in the appropriate system.
6. Prepare monthly reports and update provider databases as necessary. Assist with routine and special reporting requirements.
7. Prepare and send email and phone blasts to providers to verify demographic information.
8. Work returned mail from providers that are a result of Network Management mail outs.
9. Create data accuracy audit reporting through the provider data center. Prepare and process provider change forms as a result of the data accuracy audits.
10. Research, follow up and make updates to data sources as identified.
11. Communicate and interact effectively and professionally with co-workers, management, customers, etc.
12. Comply with HIPAA, Diversity Principles, Corporate Integrity, Compliance Program policies and other applicable corporate and departmental policies.
13. Maintain complete confidentiality of company business.
14. Maintain communication with management regarding development within areas of assigned responsibilities and perform special projects as required or requested.

JOB REQUIREMENTS:

1. Bachelor Degree OR 4 years’ experience in the health care/insurance industry.
2. Plus 1 year health care network management, health care customer service or health care product experience.
3. Knowledge of policies, products and procedures; contracts, applications and products.
4. PC proficiency including Word and Excel.
5. Verbal and written communication skills to compose business correspondence.
6. Problem solving skills
7. Analytical and reporting skills to develop reports and analyze data.

PREFERRED JOB REQUIREMENTS:

1. Knowledge of claims processing systems.

HCSC Employment Statement:

HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.