Provider Network Analyst

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☕ Washington – Remote

☕ Washington – Remote

💵 $73k - $111.7k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🛜 Network Engineer / Network Administrator

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Community Health Plan of Washington

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 1992

⚕️ Healthcare Insurance

👥 B2C

Healthcare Insurance • B2C

Community Health Plan of Washington is a nonprofit health plan founded in 1992 by Washington’s community health centers that provides Medicaid (Apple Health), Medicare Advantage, Dual-eligible, and Individual & Family insurance plans across Washington state. It offers care management, behavioral health, virtual care, member support and community services, and programs such as rewards, language assistance, and provider networks to serve members and community health needs.

📋 Description

• This position is responsible for provider network performance analysis, development of provider monitoring of network data elements and standards to ensure network capacity, to include Behavioral Health provider access. • The role partners with cross functional teams to deliver insights that support network strategy. • Leads network performance analytics, including KPI trend analysis, network access and adequacy analysis, and identification of network gaps and improvement opportunities. • Develops and maintains model to assess and monitor Community Health Plan network performance and development strategies, ensuring alignment with organizational goals. • Collaborates with subject matter experts to track key performance indicators, identify trends and recommend interventions for network improvement. • Analyzes demographic and utilization data, providing insights to support regulatory filings and identify opportunities for network expansion. • Monitor Medicare network to identify access and gap issues and provide analysis for resolution in support of monthly reporting and annual CMS network and exception process submissions. • Maintains plan HSD tables and monthly Medicare reporting according to CMS standards, researching data discrepancies to correct identified issues when applicable. • Responsible for submission of Provider Network Form A Certification letter to the OIC, to include monitoring files being available for auto-submission by IT. • Collaborate on contracting provider data gaps to ensure reliability, completeness, and consistency. • Analyzes Behavioral Health network and outreach in support of Quarterly HCA Provider Network Submission, to include regular review of geographic/service coverage of Behavioral Health Agencies. • Supports Behavioral Health AADR process through data analysis and reporting, in alignment with contract department review. • Develops Mental Health Assessment utilizing claims information and compilation of data sets to support analysis.

🎯 Requirements

• Have a bachelor’s degree in a related field or an equivalent combination of education and highly relevant experience, required. • Have a minimum of three (3) years’ experience working with health care professionals. • Have a minimum of three (3) years’ experience in managed care, required. • Have knowledge of Centers for Medicare & Medicaid Services (CMS), Healthcare Authority (HCA), Office of the Insurance Commissioner (OIC) Washington State managed care network regulatory requirements. • Have a minimum of two (2) years of experience managing large amounts of complex data and reconciling data output. • Have experience in project coordination and office support, preferred.

🏖️ Benefits

• Medical, Prescription, Dental, and Vision • Telehealth app • Flexible Spending Accounts, Health Savings Accounts • Basic Life AD&D, Short and Long-Term Disability • Voluntary Life, Critical Care, and Long-Term Care Insurance • 401(k) Retirement and generous employer match • Employee Assistance Program and Mental Fitness app • Financial Coaching, Identity Theft Protection • Time off including PTO accrual starting at 17 days per year • 40 hours Community Service volunteer time • 10 standard holidays, 2 floating holidays • Compassion time off, jury duty