Provider Data Integrity Analyst - MSO Contracting - Full Time 8 Hour Days (Exempt) (Non-Union)
About The Position
Reporting to the Manager of Payor Relations and Reimbursement, the Provider Data Integrity Analyst plays a critical role in maintaining the accuracy and integrity of provider data across Keck Medicine of USC's faculty practice plans, hospitals, and affiliated clinical enterprises as it pertains to payer enrollment. This position supports payer enrollment, provider contracting, payer updates by auditing provider rosters, updating payer systems, and ensuring alignment between internal academic, clinical, and payer-facing systems. The Provider Data Integrity Analyst serves as a key steward of provider data, supporting accurate claims processing, regulatory compliance, directory accuracy, and network integrity for faculty physicians, advanced practice providers, residents, fellows, and allied health professionals.
Requirements
- Bachelor’s Degree Information Management, Healthcare Information, Business, Mathematics, Statistics, or related fields.
- Experience in Healthcare environment working in Credentialing and Provider Enrollment.
- Ability to develop indicators, monitoring and evaluation systems as well as methods to gather data to provide analysis of trends or other relevant relationships.
- Strong working knowledge of current Microsoft operating systems (to include creating reports, tables and queries).
- Strong analytical and problem solving skills.
- Motivated to acquire new skills and knowledge or improved performance while working under pressure.
- Strong work ethic and completes tasks in a timely and efficient manner.
- Effective and clear communication, influencing, partnering skills, using appropriate channels to maintain working relationships.
- Ability to prioritize and manage multiple deadlines in a fast-paced environment
- Progressive experience with data extracts, manipulation and/or database management.
- Experience in Provider Rostering and Payer enrollment.
Nice To Haves
- Experience supporting regulatory audits or payer reconciliations.
- Clear and professional written and verbal communication skills.
- Experience working in an academic medical center or faculty practice plan.
Responsibilities
- Audit, reconcile, and validate provider rosters and loaded provider records across internal systems (faculty and KCMG practice plans, hospital systems, credentialing platforms) and external payer systems and directories for quality, financial, and regulatory accuracy.
- Ensure accurate provider demographic, practice location, specialty, and affiliation data for faculty and KCMG physicians, advanced practice providers, trainees, and affiliated providers.
- Process and track provider enrollments, demographic updates, specialty changes, revalidations, and terminations in payer and internal systems.
- Identify, investigate, and resolve discrepancies between contracting records, credentialing data, payer enrollment files, and provider directories; provide documented findings and remediation recommendations.
- Analyze provider roster files and data extracts using Excel and reporting tools to identify errors, trends, gaps, and systemic data quality issues.
- Develop, produce, and distribute provider- and network related reports and dashboards supporting operational decision making, compliance, accreditation, audit readiness, and provider issue resolution.
- Support payer roster submissions, directory attestations, periodic reconciliations, and corrective action efforts.
- Serve as a subject matter expert for provider data governance, directory accuracy standards, and payer and regulatory audit preparation.
- Respond to payer inquiries, provider data disputes, and internal and external audit requests in a timely and professional manner.
- Manage and support the integrity of provider data.
- Coordinate with Provider Contracting, Payer Enrollment, Credentialing, Revenue Cycle, IT, and external payers.
- Performs intermediate spreadsheet analyses and database solutions using tools such as Excel and Microsoft Word.
- Develop and maintain provider data documentation, standards, procedures, and audit trails to support internal controls, compliance, and sustainability.
Benefits
- Fire Life Safety Training (LA City) If no card upon hire, one must be obtained within 30 days of hire and maintained by renewal before expiration date. (Required within LA City only)
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
