Provider Network Data Integrity Analyst

🔥 0 minutes ago

🧀 Wisconsin – Remote

🧀 Wisconsin – Remote

💵 $24 - $38 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

🧐 Analyst

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Sanford Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1894

🛡️ Insurance

🏥 Healthcare

⚕️ Healthcare Insurance

Insurance • Healthcare • Healthcare Insurance

Sanford Health is the largest rural health system in the United States, dedicated to transforming the healthcare experience and providing access to world-class healthcare in America's heartland. Headquartered in Sioux Falls, South Dakota, Sanford Health serves over 1. 4 million patients and nearly 200,000 health plan members across 250,000 square miles. The integrated health system includes 48 medical centers, 211 clinic locations, and more than 160 senior living centers, employing 2,900 physicians and advanced practice providers. Sanford Health is committed to offering compassionate care through its Centers of Excellence, focusing on specialties such as cancer, orthopedics, women’s health, and genetics. Additionally, it provides affordable health insurance, engages in extensive clinical trials, and supports personalized genetic medicine.

📋 Description

• 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