PROVIDER NETWORK DATA ADEQUACY ANALYST
Telecommute Option - Must reside in ID, OR, UT or WA
WHO WE NEED
The Network Adequacy & Access Analyst serves as a data and analytic consultant for functional business areas by producing and analyzing provider network adequacy reports and preparing recommendations to Network VPs on network changes to enhance access and value. This role will serve as the central source for network adequacy reporting and ad hoc requests and will become a strategic partner by providing proactive recommendations for improving and building out our network adequacy requirements. You will be working with a highly collaborative team made up of super talented analysts.
Normally to be proficient in the competencies listed below
Network Adequacy & Access Analyst would have
* Bachelor's degree in Business, Health Care Administration, Data Analysis, or related field
* 5 years of related experience
* Or equivalent combination of education and experience.
* Experience identifying, implementing, and monitoring network adequacy-based projects.
YOUR ROLE:
* Responsible for ensuring Cambia is meeting network adequacy requirements for Medicare Advantage and Qualified Health Plan networks, as well as local regulatory network adequacy requirements across a broad range of specialties and geographies.
* Conducts regulatory filings and submission of required reporting for provider network adequacy and access to maintain compliance with state, federal, and CMS requirements, and resolves all questions, issues, and objections related to such filings, such as Medicare HSD tables.
* Responsible for analysis of access gaps and opportunities by provider specialty, and consolidating data for the purpose of recommending network changes.
* Responsible for assessing provider networks using efficiency and effectiveness data for the purpose of network architecture.
* Provides analytical support and supports internal customers with network assessments and corrective actions to address network deficiencies and opportunities.
* Evaluate existing network adequacy policies and procedures, including verification of compliance standards, lead implementation of recommended updates, and development of new policies and procedures.
* Performs regular network adequacy evaluations to support provider contract negotiations, provider terminations, and provider network optimization.
* Produce summaries that interpret network adequacy and access report outcomes and findings and suggest strategies and recommendations for improvement to contracting teams.
WHAT YOU BRING:
* Extracts provider data from source system, validates data, and runs queries using Quest Analytics (nice to have).
* Experience working for a health plan/payor environment dealing with provider data, network development, and network analysis.
* Knowledge of general database query, tools, and methodology. (SQL, Oracle, Greenplum, Toad, MS Access)
* Ability to organize, plan and prioritize assignments within multiple projects and to meet deadlines
* Ability to infer insights from data with regards to network access and value of care by provider within a medical specialty.
* Must be able to work with minimal direction and be very flexible to coordinate complex activities that are often subject to rapid or extensive changes.
* Demonstrated knowledge of MS Office products with the ability to learn corporate software as needed.
* Demonstrated success with project management.
* Advanced oral and written communications skills.
* Proven ability to perform difficult analytical tasks with minimal supervision.
The base pay annual salary range is: 83.5k-136k
The bonus target for this position is 15%
At Cambia, we take a variety of factors into account when creating a
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