Provider Network Analyst

Community Health Plan of Washington•Seattle, WA

20h•$73,010 - $111,710•Onsite

About The Position

This position is responsible for provider network performance analysis, development of provider monitoring of network data elements and standards to ensure network capacity, to include Behavioral Health provider access. The role partners with cross functional teams to deliver insights that support network strategy.

Requirements

Have a bachelor’s degree in a related field or an equivalent combination of education and highly relevant experience, required.
Have a minimum of three (3) years’ experience working with health care professionals.
Have a minimum of three (3) years’ experience in managed care, required.
Have knowledge of Centers for Medicare & Medicaid Services (CMS), Healthcare Authority (HCA), Office of the Insurance Commissioner (OIC) Washington State managed care network regulatory requirements.
Have a minimum of two (2) years of experience managing large amounts of complex data and reconciling data output.
Demonstrated excellent oral, written, interpersonal and analytical skills.
Effective skills in data management accuracy, QA processes and ability to work with multiple and complex data sets on cross-systems.
Ability to independently identify and analyze trends and initiate proactive interventions.
Advanced proficiency with Windows software including Microsoft Word, Excel, and Access.
In-depth knowledge of products and managed care operations.
Complete and successfully pass a criminal background check.
Has not been sanctioned or excluded from participation in federal or state healthcare programs by a federal or state law enforcement, regulatory, or licensing agency.

Nice To Haves

Have experience in project coordination and office support, preferred.
Experience with SQL, Pivot Tables and PowerPoint preferred.

Responsibilities

Leads network performance analytics, including KPI trend analysis, network access and adequacy analysis, and identification of network gaps and improvement opportunities.
Develops and maintains model to assess and monitor Community Health Plan network performance and development strategies, ensuring alignment with organizational goals.
Collaborates with subject matter experts to track key performance indicators, identify trends and recommend interventions for network improvement.
Analyzes demographic and utilization data, providing insights to support regulatory filings and identify opportunities for network expansion.
Monitor Medicare network to identify access and gap issues and provide analysis for resolution in support of monthly reporting and annual CMS network and exception process submissions.
Maintains plan HSD tables and monthly Medicare reporting according to CMS standards, researching data discrepancies to correct identified issues when applicable.
Responsible for submission of Provider Network Form A Certification letter to the OIC, to include monitoring files being available for auto-submission by IT.
Collaborate on contracting provider data gaps to ensure reliability, completeness, and consistency.
Analyzes Behavioral Health network and outreach in support of Quarterly HCA Provider Network Submission, to include regular review of geographic/service coverage of Behavioral Health Agencies.
Supports Behavioral Health AADR process through data analysis and reporting, in alignment with contract department review.
Develops Mental Health Assessment utilizing claims information and compilation of data sets to support analysis.
Leads the creation and execution of process improvement strategies to optimize departmental systems and align performance with organizational objectives.
Collaborates across departments and teams to initiate and deliver projects that advance network strategy and fosters interdepartmental partnerships.
Supports the development of internal consulting capabilities for CHPW to strengthen delivery systems performance.
Participate in cross-training with department analysts and program managers.
Other duties as assigned.