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Provider Network Analyst

  • Ref: 283798
  • Type: Direct Hire
  • Location: Fort Lauderdale, FL
  • Industry: Insurance
  • Job Level: Experienced Non-Manager
  • Pay: $50,000

Opportunity Description

The Provider Network Analyst will support the Network Management team as needed. The Provider Network Analyst will update and compile reports for Health Plans, Providers, and internal departments. Support the Department in completing and tracking of Client audits. Learn various internal software to assist in utilization reviews and adequacy of provider networks. This is a direct hire in Fort Lauderdale, FL in the insurance industry. 

Company Information

Our client is a medical management organization, which delivers a portfolio of integrated services. The company is located in Fort Lauderdale, FL and has been in the business for over twenty years. As a motto, their market leadership position is of the utmost importance.

Job Duties

  • Assist the Provider Network Department in completing monthly and quarterly reporting requirements to its clients.
  • This position requires strong analytical skills to thrive in a fast-paced environment as well as be comfortable with management exposure.
  • Refresh the data files monthly of the current health plans in order to review the Network adequacy of our provider specialties.
  • Assist department in reviewing network accessibility (including quarterly geo-map analysis).
  • Assist department in annual audits of health plans.
  • Refresh the data to analyze the claims utilization and cost performance of the specialty networks.
  • Assist department in reviewing network accessibility (including quarterly geo-map analysis).
  • Work on various special projects and ad-hoc reports on an as-needed basis.
  • Work and support multiple members of the department conducting research via the internet, internal software programs, spreadsheets, health plan directories, etc. to support the department with current and new projects.
  • Research information may be requested in various reporting formats.

Education

  • Required Education and Experience: Bachelor's degree or equivalent work experience in data analysis experience. 

Experience & Skills Required

  • Two or three years background in the managed care industry. 
  • Ensure adherence to department and organizational standards, policies and procedures, including HIPAA.
  • Ensure integrity of data entered into Company systems and/or databases.
  • Ability to safely and successfully perform essential job functions consistent with the ADA, FMLA, and other federal, state, and local standards, including meeting qualitative and/or quantitative productivity standards.
  • Ability to maintain reasonably regular, punctual attendance consistent with the ADA, FMLA, other federal, state, and local standards, and company attendance policies and procedures.
  • Ability to come to work and work the regular schedule and shift for the position.
  • Compliance with all personnel policies and procedures.
  • Ability to work both independently and as part of a team of professionals.
  • Knowledge of with various aspects of billing, claims adjudication and claims payment for the network specialties. This should include, but may not be limited to Medical terminology, CPT Coding, ICD Code Sets, and CMS Fee Schedules. 
  • Bilingual Spanish is nice to have.