Sacramento, CA, United States
High School Diploma or GED
The Provider Network Data Analyst is responsible for maintaining the provider network information for **MEMBERS ONLY**SIGN UP NOW***. Plus through the use of the HealthRules system. Activities include making strategic recommendations for network composition; creating and maintaining a provider database to enable accurate claims processing and provider directories; designing, overseeing and performing analytical projects to support operations initiatives and assisting with network, operations and care management business project initiatives to further the advancement of strategic goals set forth by **MEMBERS ONLY**SIGN UP NOW***. Plus. This position is responsible for managing certain interactions between providers, the health plan, medical groups, risk bearing organizations and other **MEMBERS ONLY**SIGN UP NOW***. system provider data resources.
High School diploma required. BA/BS degree or equivalent combination of education and experience desired.
Must have 3+ years in a managed care or health insurance environment with progressive and relevant operations experience.
Must have 3+ years in an provider network data support role
Demonstrated ability to oversee projects and assigned programs.
Experience interacting with health care providers and familiarity with health care billing and payment practices.
Ability to lead, communicate and interact with all levels of the organization, including senior management, to provide recommendations and influence decision-making.
Experience in managing multiple, simultaneous, complex programs.
Knowledge of health care contracting language, requirements and methods to support the development and maintenance of contract compliance, contract language review and analysis.
Must possess some familiarity and understanding of DMHC regulations, various health care reimbursement models, pricing mechanisms, managed care and payer relationships.
Must have knowledge of database management and data accuracy verification techniques.
Required skills include ability to build collaborative working relationships with diverse individuals and organizations.
Strong analytical and problem solving skills.
Ability to operate independently, confidentially, and to garner confidence from SHP leadership, Sutter affiliates and Sutter Physician Services staff
Ability to work within and promote team environment concepts; exceptional interpersonal skills including oral and written communications in a wide variety of circumstances.
Proficient in using Microsoft Word, Excel, Visio and PowerPoint, and internet research
Must demonstrate knowledge of HIPAA, Health Care Reform, Business Code of Ethics and government regulated programs
**MEMBERS ONLY**SIGN UP NOW***. Plan
8 Hour Shift
Days of the Week Scheduled:
Hrs Per 2wk Pay Period: