Verified Job
Work from home
Provider Network Operations Data Analyst
Work from home
#669760
Remote / WFH
Job Description
Role Overview: The Provider Network Operations Data Analyst plays a key role in maintaining accurate provider data and fostering strong relationships between the health plan and its contracted and non-contracted providers across Medicaid, Medicare, and Exchange products. This role ensures provider information is correctly represented in all operating systems and serves as a proactive liaison to resolve provider-related issues efficiently.
Work Arrangement:
Remote – The associate can work remotely from anywhere in the Detroit Metro area, Michigan, and must be able to attend two weeks of in-office training at our Southfield, Michigan, location.
Responsibilities:
Serve as a primary point of contact for providers, ensuring timely resolution of inquiries and issues.
Communicate plan policies, procedures, and regulatory updates clearly and professionally.
Maintain and monitor provider data to ensure accuracy across all systems.
Review and process provider data intake forms for completeness.
Track and document provider data changes to ensure timely updates and compliance with turnaround standards.
Escalate discrepancies or requests that conflict with business processes or contract terms.
Ensure timely and accurate management of provider contracts, including terms and reimbursement details.
Investigate and respond to member complaints within established timelines.
Identify and report compliance issues in accordance with plan policies and procedures.
Demonstrate working knowledge of provider databases (e.g., Facets) and reimbursement methodologies.
Collaborate with internal departments to manage medical costs and support strategic initiatives.
Demonstrates working knowledge of Facets, particularly the provider database, and consistently communicates updates, such as additions, deletions, or corrections, to the provider maintenance department.
Education & Experience:
Bachelor’s degree or equivalent work experience required.
At least one year of experience working with healthcare providers and provider relations
3 years of experience in managed care or health insurance preferred.
Proficiency in Microsoft Excel & Access (formulas, pivot tables, charts/graphs).
Strong analytical skills (non-IT focused)
Work Arrangement:
Remote – The associate can work remotely from anywhere in the Detroit Metro area, Michigan, and must be able to attend two weeks of in-office training at our Southfield, Michigan, location.
Responsibilities:
Serve as a primary point of contact for providers, ensuring timely resolution of inquiries and issues.
Communicate plan policies, procedures, and regulatory updates clearly and professionally.
Maintain and monitor provider data to ensure accuracy across all systems.
Review and process provider data intake forms for completeness.
Track and document provider data changes to ensure timely updates and compliance with turnaround standards.
Escalate discrepancies or requests that conflict with business processes or contract terms.
Ensure timely and accurate management of provider contracts, including terms and reimbursement details.
Investigate and respond to member complaints within established timelines.
Identify and report compliance issues in accordance with plan policies and procedures.
Demonstrate working knowledge of provider databases (e.g., Facets) and reimbursement methodologies.
Collaborate with internal departments to manage medical costs and support strategic initiatives.
Demonstrates working knowledge of Facets, particularly the provider database, and consistently communicates updates, such as additions, deletions, or corrections, to the provider maintenance department.
Education & Experience:
Bachelor’s degree or equivalent work experience required.
At least one year of experience working with healthcare providers and provider relations
3 years of experience in managed care or health insurance preferred.
Proficiency in Microsoft Excel & Access (formulas, pivot tables, charts/graphs).
Strong analytical skills (non-IT focused)
