Provider Data Management Analyst- Health Plan

Overview

Location:

Mockingbird Towers 4th FLR
PCHP
- Parkland Community Health Plan

Education

• Bachelor's degree in healthcare administration, business administration, information systems, or a related field required.

Experience

• Two years of provider data management experience, including:

• Experience managing and submitting regulatory files, including Medicaid provider files and the Master Provider File (MPF), with an understanding of compliance requirements.
• Experience with QNXT or similar claims management & provider data systems required.

Equivalent Education and/or Experience

• May have an equivalent combination of education and/or experience in lieu of specific education and/or experience as stated above.

Skills or Special Abilities

• Excellent verbal and written communication skills including the ability to communicate effectively and professionally across disciplines and cross functional teams. Ability to communicate complex information in understandable terms. *
• Strong interpersonal and conflict resolution skills with the ability to establish and maintain effective working relationships across and beyond the organization.
• Excellent analytical, attention to detail, organizational, and problem-solving skills.
• Strong technical knowledge of healthcare configuration systems (e.g., QNXT).
• Proficiency in data analysis and testing methodologies.
• Knowledge of regulatory compliance requirements for provider data and claims systems.
• Strong time management and organizational skills with the ability to manage multiple demands and respond to rapidly changing priorities.
• Ability to write clearly and succinctly with a high level of attention to detail.
• Proficient computer and Microsoft Office skills and other analytical tools. Ability to learn new software programs.
• Knowledge of Texas Medicaid, National Committee for Quality Assurance (NCQA), the Uniformed Managed Care Contract, and the Uniform Managed Care Manual.

• Ensure timely and accurate updates to provider data in systems, including provider demographic changes, terminations, and additions.
• Create and update documentation for provider data maintenance processes.
• Respond to inquiries related to provider data from internal teams, such as Claims, Operations, and Network/Provider Relations.
• Support the implementation of new processes and workflows for provider data maintenance.

• Integrate health literacy principles into all communication including Members and Providers.
• Support strategies that meet clinical, quality and network improvement goals.
• Promote the use of Health Information Technology to support and monitor the effectiveness of health and social interventions and make data-driven recommendations as needed.
• For staff in clinical roles, foster collaborative relationships with members and/or providers to promote and support evidence-based practices and care coordination.
• Perform regular audits of provider data to identify and resolve discrepancies or inaccuracies.

• Ensures work is carried out in compliance with regulatory and/or accreditation standards as well as contractual requirements.
• Assist with provider onboarding and credentialing processes, ensuring compliance with health plan policies.
• Collaborate with internal and external stakeholders to validate and maintain provider records in alignment with organizational policies and regulatory requirements.
• Generate and validate reports, including fall out reports for regulatory files such as Medicaid provider files and the MPF, ensuring compliance with state and federal guidelines.

• Promotes and supports a culturally welcoming and inclusive work environment.
• Acts with the highest integrity and ethical standards while adhering to Parkland's Mission, Vision, and Values.
• Adheres to organizational policies, procedures, and guidelines.
• Completes assigned training, self-appraisal, and annual health requirements timely.
• Adheres to hybrid work schedule requirements.
• Attends required meetings and town halls.
• Recognizes and communicates ethical and legal concerns through the established channels of communication.
• Demonstrates accountability and responsibility by independently completing work, including projects and assignments on time, and providing timely responses to requests for information.
• Maintains confidentiality at all times.
• Performs other work as requested that is reasonably related to the employee's position, qualifications, and competencies.

• Identifies ways to improve work processes and improve customer satisfaction. Makes recommendations to supervisor, implements, and monitors results as appropriate in support of the overall goals of PCHP.

• Stays abreast of the latest developments, advancements, and trends in the field by attending seminars/workshops, reading professional journals, actively participating in professional organizations, and/or maintaining certification or licensure. Integrates knowledge gained into current work practices.
• Maintains…