Analytics
Analyst, Provider Data Management
Pune, Maharashtra, India

             

Job title

Analyst, Provider Data Management

 

Department

PDM

Report To

 

No of yrs. of exp

1-4

Work Location

Pune

No of Positions

1

Assigned Recruiter

Pooja Mandlekar

Talent Partner

Sagar Guha

 

Version Control

Version No.

Date

Remark

Updated by

 

 

 

 

 

It’s Time For A Change…

Your Future Evolves Here

Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving force that brings us to work each day. We believe in embracing new ideas, challenging ourselves and failing forward. We respect and celebrate individual talents and team wins. We have fun while working hard and Evolenteers often make a difference in everything from scrubs to jeans.

Are we growing? Absolutely—56.7% in year-over-year revenue growth in 2016. Are we recognized? Definitely. We have been named one of “Becker’s 150 Great Places to Work in Healthcare” in 2016 and 2017, and one of the “50 Great Places to Work” in 2017 by Washingtonian, and our CEO was number one on Glassdoor’s 2015 Highest-Rated CEOs for Small and Medium Companies. If you’re looking for a place where your work can be personally and professionally rewarding, don’t just join a company with a mission. Join a mission with a company behind it.

 

Position summary

Evolent Health is looking for an Analyst, Provider Data Management to be a key member of the Provider Data Management team. Reporting to the Senior Director or Director, Provider Data Management, this individual will play a critical role in executing Evolent Health’s mission by working directly with our partners, focused on coordinating, monitoring, trending and supporting report requirements of business operational and clinical programs within Provider Data Management. This Analyst will work with both internal and external business partners to implement ongoing operational monitoring, resolve service barriers, develop solutions to improve effectiveness and identify continuous improvement initiatives to increase service level performance.

 

 

 

Essential functions

 

  1. Serves as a liaison between Third-Party Administrator (TPA)/Business Process Outsourcing (BPO) partner, internal team members and partner organizations providing leadership for provider data enrollment and management activities; acts as liaison with technology team and business product team members
  2. Defines analysis methodology and provides analytic support
  3. Analyzes existing systems to recommend enhancements and creates new approaches to reduce manual processes and maximize the business efficiencies
  4. Analyzes data from conceptualization through presentation, using analytical tools, data analysis methodology, presentation software, and strong communication skills
  5. Identifies, evaluates, and implements new data-driven strategies and processes for the department
  6. Develops tools and reports that lend valuable insights which capitalize on a combination of internal and external data
  7. Recommends enhancements to existing systems in accordance to business needs by creating ad hoc and standard reports, as well as information delivery technologies
  8. Prepare reports in an accurate, concise and timely fashion
  9. Performs data collection, analysis, reporting
  10. Provide guidance and support to claims and operations personnel to assist with resolution of provider data and claims issues, with an emphasis on root cause analysis and resolution
  11. Compile, review and analyze management reports and take appropriate action
  12. Identify and advise Claims, Provider Data Management, Medicaid and Medicare Operations, and other operational areas, of trends, problems, and issues and recommended course of action; ensure timely communication; participate in the development and implementation of solutions
  13. Monitor adherence to the efficiency and service level goals including volume, processing, timeliness, accuracy and other internal and partner metrics
  14. Compose, submit and track claim system questions and configuration requests to correct identified systemic issues
  15. Prioritize issues identified by TPA/BPO, internal team members and/or partner representatives; and monitor progress in the resolution of the issues
  16. Develop deep understanding of processing capabilities and limitations of claims and benefits with TPA/BPO systems, tools and resources; provide recommendations to meet partner requirements
  17. Confirm that provider data elements have been accurately set up within the claims payment system and are aligned with requirements, as specified by partner materials
  18. Create and report operational tracking metrics and dashboards for monitoring claims, provider disputes and benefits performance
  19. Coordinate corrective action plans with partner and TPA/BPO operations services management to resolve known issues and defects
  20. Support internal partner team members with the resolution of identified issues
  21. Work with cross functional departments to identify and resolve issues leading to incorrect provider data and inaccurate claims payment
  22. Serve on various committees and attend required meetings
  23. Perform other duties and projects, as assigned

Key Competencies and Success Factors:

  • Live the values: Integrity, Community, Collaboration and Stewardship, as defined in the associate performance appraisal
  • Excellent verbal and written communication
  • Detail oriented with excellent organizational abilities and capacity to enter and assess data elements with a focus on accuracy and timeliness
  • Able to work collaboratively with associates and key stakeholders across the enterprise
  • Capable to handle provider inventory and multiple projects simultaneously, with a high degree of success
  • Adapt to ever changing priorities while performing detailed work in an efficient, effective, and accurate manner

 

Academic Qualification

  • Associate’s degree or equivalent experience
  • Bachelor’s degree in Computer Science, Statistics, Mathematics or related field, preferred
  • One (1) to three (3) years of experience in collecting, analyzing, and presenting data and making recommendations to management through executive summaries
  • Experience working within a health plan, managed care organization, provider operated healthcare environment or TPA/BPO
  • Extensive knowledge of computers and related software applications, with advanced expertise with programs such as Word, PowerPoint, Excel, Project, Access
  • One (1) to (3) years data analysis and business intelligence experience working with Business Intelligence suites such as Qlikview, SSRS, Power BI, Tableau or other enterprise class tools, preferred
  • Prior supervisory or lead experience, preferred
  • Experience with Medicare Advantage and Medicaid plans
  • Demonstrated exceptional active listening and communications skills
  • Experience in systems and languages related to database lifecycle management such as Microsoft Access, Python, SQL Server, Visual Basic for Applications (VBA), etc., preferred

 

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