Provider Network Analyst

Responsibilities

• 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.
• 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.
• Monitors Medicare network to identify access and gap issues and provides 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, including monitoring files being available for auto‑submission by IT.
• Collaborates 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, including 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.

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.
• Have experience in project coordination and office support, preferred.
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