Job
Description
Are we growing? Absolutely and Globally. In 2021 we grew our teams by almost 50% and continue to grow even more in 2022. Are we recognized as a company you are supported by for your career and growth, and a great place to work? Definitely. Evolent Health International (Pune, India) has been certified as Great Places to Work in 2021. In 2020 and 2021 Evolent in the U.S. was both named Best Company for Women to Advance list by Parity.org and earned a perfect score on the Human Rights Campaign (HRC) Foundation s Corporate Equality Index (CEI). This index is the nations foremost benchmarking survey and report measuring corporate policies and practices related to LGBTQ+ workplace equality. What You ll Be Doing: Job Description Evolent Health is looking for a Provider Data Specialist to be a key member of the PDM Operations team. Reporting to the Supervisor of 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 Network Management. This Provider Data 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 levels. Essential functions Serve as a liaison between the internal team members and partner organization providing support for provider data enrollment activities; acts as liaison with technology team and business product team members. Defines analysis methodology and provides analytic support. Analyzes existing systems to recommend enhancements and creates new systems to reduce manual processes and maximize the business efficiencies. Analyzes data from conceptualization through presentation and requires proficiency with analytical tools, knowledge of data analysis methodology, use of presentation software, and strong communication skills. Identifies, evaluates, and implements new data-driven strategies and processes for the department Develops tools and reports that lend valuable insights that capitalize on a combination of internal and external data. Recommends enhancements to existing systems in accordance to business needs by creating ad hoc and standard reports as well as information delivery technologies. Prepare reports in an accurate, concise and timely fashion. Performs data collection, analysis, reporting. Provide guidance and support to all claims and operations personnel towards resolution of provider data and claims problems with an emphasis on root cause analysis and resolution of problems Compile, review and analyze management reports and take appropriate action Identify and advise Claims, Provider Network Management, Medicare Operations and other operational areas of trends, problems, and issues as well as recommended course of action; ensure timely communication; participate in the development and implementation of solutions Monitor adherence to the efficiency and service level goals including volume, processing, timeliness, accuracy and other metrics. Compose, submit and track claim system questions and configuration requests to correct identified systemic issues Prioritize issues identified by TPA/BPO, internal team members and/or partner representatives and monitors progress in the resolution of the issues Develop deep understanding of processing capabilities and limitations of claims and benefits with TPA/BPO systems, tools and resources; provide recommendations to meet plan requirements Confirm that all provider data elements have been set up within the claims payment system and are aligned with the requirements as specified by the plan materials. Create and report operational tracking metrics and dashboards for monitoring claims, provider disputes and benefits performance. Coordinate corrective action plans with partner/client and TPA/BPO operations services administrator to resolve issues. Support internal plan team members with the resolution of daily issues. Work with other departments to identify and resolve problems leading to incorrect provider data and issues regarding payment of claims. Serve on various committees and attends required meetings. Perform other duties and projects as assigned Key competencies/skill/success factors: Experience working within a health plan, managed care organization, provider operated healthcare environment or third party administrator Good Knowledge on Python, SQL Server- SSMS, SSRS. Extensive knowledge of PCs and related software applications, such as Word, PowerPoint, Excel, Project Demonstrated exceptional active listening and communications skills Experience in systems and languages related to database lifecycle management such as MS Access, Visual Basic, etc Qualification and Experience: Required Associates Degree or equivalent 2-4 years of experience in collecting, analyzing, and presenting data and recommendations to management Big plus Bachelor s degree in Computer Science, Statistics, Mathematics or related field 1-3 years data analysis and business intelligence experience working with BI suites such as Power BI, SSRS or other enterprise class tools Mandatory Requirements: Employees must have a high-speed broadband internet connection with a minimum speed of 50 Mbps and the ability to set up a wired connection to their home network to ensure effective remote work. These requirements may be updated as needed by the business.
