Demographic Analyst-Provider Data -REMOTE

Job SummaryThe Senior Demographics Analyst plays a crucial role in maintaining accurate and comprehensive provider information within the health plans systems. This individual is responsible for a wide range of duties related to provider data management, ensuring compliance with regulatory requirements, facilitating efficient claims processing, and supporting overall network operations. This role requires a high level of expertise and the ability to work independently to resolve complex issues and support departmental goals. Primary ResponsibilitiesProvider Data Management Oversees and maintains accurate provider demographic information in the sPayer and Facets platforms by ensuring data integrity and consistency across all systems feeds. Processes new provider setups, updates, and terminations, including managing the entire lifecycle of provider records. Compliance & Auditing Ensures compliance with state and federal regulations, including those related to provider enrollment, credentialing, directory, and data accuracy. Conducts regular audits of provider data to identify and resolve discrepancies, ensuring adherence to quality standards. Updates delegated provider rosters monthly and on an ad hoc basis to maintain state compliance. Problem Resolution & Support Serves as a primary liaison between the health plan departments and providers, resolving complex inquiries and addressing network-related issues. Provides direct support and oversight for trouble shooting and resolution of Blue Provider Data submission issues related to data quality. Collaborates with internal departments (e.g., Contracting, Credentialing, Provider Relations) to resolve provider inquiries and contractual disputes. Provides support and guidance to less experienced team members, acting as a subject matter expert in provider data management processes. Reporting & Analysis Generates reports and statistical data for management review, follow-up, and resolution. Analyzes provider data to identify trends, potential issues, and opportunities for process improvement. Presents findings and insights to management, collaborating on solutions to enhance efficiency and metrics. Workflow Optimization Actively participate in project implementation and process improvement initiatives to streamline department operations. Develops and implements strategies to optimize data collection and management for improved efficiency and accuracy. Creates and maintains automated process flows ensuring that downstream databases for contract provider networks, prior authorization, and third-party liability are accurate. Education and Experience Bachelors degree in healthcare administration, health information management, or an equivalent combination of education and experience. 5 years of experience working with managed care or the healthcare industry, with a focus on provider data or network administration. Preferred Use Of SPayer, Facets, And/or SProvider Systems. Proficiency in Microsoft Office Suite, including Access and Excel. Strong understanding and experience with database management systems and reporting tools. Familiarity with relevant healthcare industry regulations and systems, such as HIPAA, FACETS, NPPES, PEGA, NCQA, ICE, DMHC, DHCS, and CMS. Excellent written and verbal communication skills. Strong analytical and problem-solving skills, with keen attention to detail and accuracy. Ability to work independently, manage multiple priorities, and meet deadlines. Strong organizational and time management skills. Ability to collaborate effectively with internal and external stakeholders. #J-18808-Ljbffr Apply tot his job