Provider Data Integrity Analys

Texas Children's Medical Center•Bellaire, TX

About The Position

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. Think you’ve got what it takes

Requirements

H.S. Diploma or GED
4 years Combined managed care contracting, provider reimbursement and analysis, strategic planning and/or project management experience

Nice To Haves

Bachelor's Degree

Responsibilities

Perform monthly audits and reconciliation of all Provider data within multiple systems within the Health Plan.
Ensure Health Plan data is aligned with State requirements.
Ensure all Provider updates (adds, terms, changes) are made timely and accurately into Core systems.
Monitor the reporting of Provider data to support Provider Relations teams, ensuring clean, accurate, and timely data related to State regulations.
Analyze reports and data sets for anomalies within the Provider data from multiple sources within the Health Plan.
Identify and update data discrepancies between State requirements and the Health Plan’s data.
Coordinate and collaborate with Vendors, Providers, and other departments to ensure all systems are reconciled.
Propose solutions to Business Partners for data integrity issues identified during analysis.
Maintain data standards in alignment with State and other Regulatory requirements.
Manage data discrepancies and maintenance functions efficiently, securely, and timely, adhering to 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 Provider data.
Review updates from the State pertaining to Provider data to ensure compliance.
Drive system and/or process changes to certify that all State requirements are met.
Evaluate Health Plan practices for performing this function and recommend necessary changes to support data integrity.
Evaluate datasets for consistency, completeness, accuracy, and reasonableness.
Generate data reports on a periodic basis as requested or needed for the data management process.
Identify and correct data deficiencies within the Health Plan Systems.
Collaborate with the Provider Directory Vendor, ensuring accurate and timely data.
Record and document data management activities as required, including 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 improvements identified as needed by the Health Plan to support the continued integrity of the Provider data.
Address any issues, questions, and problems in an accurate and timely manner.
Self-solve issues if provider data integrity is in question.
Educate other departments on data use and Business rules.