Provider Network Reporting Specialist

Role Description

Responsible for formatting and delivering appropriate provider network data for use in RFP responses, sales & marketing support, health plan client requirements and Compliance filings.

• Process and track requests from Sales Operations, Client Management, Managed Care Clients, and Organizational Management in an accurate and timely fashion.
• Produce and deliver Quest Analytics Network Analysis Reports (NAR), Provider Network Disruption Reports, and data analysis in a deadline driven environment.
• Manage and maintain Zelis data and Competitor data.
• Assist in producing ad hoc reports as needed; create standard recurring reports/presentations and weekly/monthly performance guarantee reports, as requested.
• Triage and fulfill queued requests related to accessibility reports, disruption and adequacy reports, network size comparisons from the RFP team, Sales VPs and RSMs, managed care clients, Compliance and other internal and external customers in an accurate and timely manner.
• Identify department reporting strategies and process improvements that ensure scalable business processes.
• Interpret and summarize results of data analysis.
• Support Network Development for network growth opportunities.
• Assure and maintain accuracy of network reporting and data integrity.
• Timeliness of achieving project goals.
• Other duties as assigned.

Qualifications

• Preferred Bachelor's Degree in Business, Healthcare Management, Accounting, Finance, Economics, Mathematics, Statistics, or Information Systems or related field or equivalent combination of experience and education.
• Proficiency in data and statistical analysis.
• Proficiency with Microsoft Office (Excel and Access preferred) and Business Objects.
• Ability to read and interpret documents such as training manuals, regulatory guidelines and statutes, audit tools, existing policies and procedures, and provider manuals.
• Ability to write routine reports and correspondence.
• Ability to speak effectively and concisely to associates of the organization and external customers.
• Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.
• Effective oral and written communication and presentations skills as well as strong interpersonal skills.

Requirements

• HIPAA & Security Requirements: All Associates must comply with the Health Insurance Portability Accountability Act of 1996 (HIPAA) as it pertains to disclosures of protected health information (PHI) as described in the Notice of Privacy Practices and HIPAA Privacy Policies and Procedures.
• Associates may have access to covered information, cardholder data or other confidential customer information which must be protected at all times.
• Associates must explicitly adhere to all data security guidelines established within the Company’s Privacy & Security Training Program.

Benefits

• Comprehensive and competitive total rewards package designed to support your health, financial well-being, and work-life balance.
• Medical, dental, and paid vision coverage.
• Paid time off and company holidays.
• Retirement savings with employer contribution.
• Employee wellness resources.
• Professional development opportunities.
• Additional benefits may include flexible work arrangements, employee assistance programs, and other programs that support you both at work and beyond.