Healthcare Data Analyst Jobs

Equality Health is an Arizona-based population healthcare company focused on improving care delivery for underserved populations through culturally-sensitive programs that improve access, quality, and patient trust. Our mission is to ensure diverse populations receive quality healthcare that improves and enriches their lives. We have developed our product portfolio around centralized technology, services and network designs intended to organize a better healthcare delivery system for cultures that have struggled with integrating into the traditional one-size-fits-all U.S. healthcare system.

About the position:

The Provider Data Reporting and Reconciliation Analyst is primarily responsible for supporting the Network Operations team with data analysis, including updating and compiling provider data reports for health plans and internal departments. This individual is also responsible for research, analysis and maintenance of payer contracts, provider database and database loads, provider participation roster, practice performance reports and evaluations of data quality and integrity.

Responsibilities:

• Identify and escalate delivery impediments, risks, issues and changes during the reconciliation initiatives and/or calibration process
• Perform analysis of network accessibility, utilization, and adequacy
• Leverage knowledge and expertise of software tools and reports to develop and implement dashboards and maps for multiple audiences
• Responsible for various special projects and ad-hoc reports as needed
• Perform provider reconciliation per health plan
• Perform other job duties as assigned
• Initiate inquiry of discrepancy with the practice and/or the health plan
• Develop and produce peer quality metric performance reports; validate data and data processes to ensure accuracy, completeness, and consistency
• Track, monitor and complete periodic audits from health plans and clients
• Ensure integrity of data entered into company systems and databases
• Develop and maintain a log to document issues and/or discrepancies, and track to resolution per health plan
• Perform membership reconciliation per health plan
• Collaborate with internal departments, business units and health plan partners on contract implementation, management and operations to identify and meet data reporting needs
• Review and research discrepancies on Exception Reports;
• Responsible for regular reporting and evaluation of data quality and integrity within our internal systems and rosters
• Perform monthly reconciliation of provider rosters obtained from multiple sources per health plan based on contract agreements
• Develop process standards, document policies and procedures for data flow
• Establish, facilitate, and participate in meetings to review, research, resolve discrepancies, and summarize outstanding items
• Ensure all data sharing and data flows meet HIPAA, security, and minimum necessary standards; collaborate with IT security, Compliance, and HR departments as needed
• Develop and maintain policies and procedures for all aspects of the role, including but not limited to, specific points of contact and process distinctions per health plan
• Ensure integrity of data entered into company systems and databases
• Create monthly and quarterly provider network reports requirements for all internal business units and health plans
• Responsible for the completion of PCP panel transfers with notification to health plans as necessary
• Maintain proficiency of various internal software tools
• Identify and recommend opportunities to improve reports and/or process with relevant information and facts
• Develop and document standards, policy and procedures for data entry and network operations data flow

Required Knowledge, Education & Experience:

• Excellent verbal, written and interpersonal communication skills; highly collaborative team approach to work
• Minimum three (3) years of experience in a directly related role in the healthcare industry
• Bachelor’s degree in Business, Data Analytics, Healthcare Administration or related field; or, an equivalent combination of education and/or experience
• Successful record of managing multiple projects with demonstrated ability to work independently in rapidly-changing environments
• Proficiency with Microsoft Office applications (including Excel) and web-based technologies

Highly Preferred Skills, Abilities & Qualifications:

• Able to present complex or technical information in a clear concise manner to audiences with varying levels of technical understandings
• Knowledge of the National Committee for Quality Assurance (NCQA), health plan employer data
• Familiarity of quality information sets (e.g., HEDIS) and Arizona Health Cost Containment System (AHCCCS) and Medicare/Medicaid Services standards and reporting requirements
• Knowledge of payer, provider and employer contracts including various payment alternatives such as fee-for-service, capitation, global budget and performance compensation
• Excellent problem-solving skills, including the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action
• Experience with provider databases and provider data management including MS Dynamic CRM
• Experience with database management in a healthcare setting

Equality Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.

This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.