Provider Network Data Integrity Analyst
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Job Description
Provider network data integrity analyst supporting Sanford Health’s Wisconsin health plan operations. Maintaining provider data, network adequacy, regulatory filings, and CMS-compliant directories.
Responsibilities:
- Maintain the accuracy, completeness, and regulatory compliance of the Health Plan’s provider network data
- Complete network adequacy filings for CMS, NCQA, DHS, and requested employer groups
- Develop and enforce data quality standards for provider and facility databases
- Complete network adequacy reviews using CMS time and distance standards
- Perform analyses and audits to identify provider network gaps and ensure corrections
- Coordinate regulatory provider network submissions and contractual obligations
- Audit and advise provider credentialing on data issues, including delegated credentialed entities
- Maintain the Health Plan Provider Directory in compliance with CMS, DHS, and Office of the Commissioner of Insurance requirements
- Organize large datasets into understandable formats for strategic planning
- Analyze providers, facilities, and patterns of care to identify potential service-area expansion opportunities
- Research and communicate regulatory directives
- Perform disruption analyses for potential Health Plan customers to improve competitiveness for bids
- Serve as a resource for strategic planning, compliance, and network analysis
- Perform other duties as assigned
Requirements:
- Bachelor’s Degree in business administration, finance, healthcare related field, computer science, or analytics
- Three years’ experience in a medical group practice, health insurance, or Health Maintenance Organization (HMO) environment
- Demonstrated knowledge of data manipulation and analytical analysis
- Proficiency with Microsoft Office suite, including Excel and Access
- Successful completion of a post-secondary medical terminology course preferred
- Understanding of geoaccess coding, provider credentialing, and medical terminology preferred
Benefits:
- Salary range of $24.00 - $38.50 per hour
- Full-time schedule with 40 scheduled weekly hours
- Remote work in Wisconsin
- EEO/AA employer; equal opportunity for M/F/Disability/Vet
- Reasonable accommodation support for applicants with disabilities
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