Provider Performance Analyst

We have partnered with a large Health Insurance company in the Philadelphia, PA area to provide them with a Provider Performance Analyst .

Responsibilities of the Provider Performance Analyst:

Develops and implements data-driven solutions to meet business requirements by producing analytics, reports and data sets across a variety of subject matters – primarily related to, but not limited to, value-based contracting, medical and quality management, population health, network management, contracting, marketing and member outreach, and new business initiatives.
Audit data to ensure the maximum level of accuracy, integrity, consistency, and completeness in the various internal/external data sources and in report submissions.
Responsible for development, maintenance and settlement of provider incentive models throughout the Family of Companies.
Generates and maintains thorough and accurate documentation related to data, databases, value-based contracting models, business rules, and reporting policies and procedures for all LOBs.
Identifies data-related issues, and conducts root cause analyses; facilitates resolution of known issues by working directly with end-users and IT staff.
Establishes business rules for accurate use of reporting data fields.
Identifies new and maintains existing sources of data to ensure the availability of information for reporting purposes.
Develops and executes test processes related to end-user data and databases; documents and tracks data-related issues, and facilitates resolution of such issues.
Supports identification of training opportunities as they relate to data comprehension and reporting; assists with creation of new models and metrics to track provider performance.

Education/Experience of the Provider Performance Analyst:

Bachelors’ degree required in relevant field.
Minimum of 3+ years of Data Analysis, Reporting, Claims, Managed Care or Healthcare experience required.
Extensive knowledge of Microsoft Office products is required.
Demonstrated skills with at least one reporting application such as: SAS Enterprise Guide, SQL and/or MS Access.
Experience developing value based programs is preferred.
Preferred project management experience including overseeing different initiatives and the coordination and completion of projects on time and within scope.

KEYWORDS:

Healthcare Industry; Health Insurance; Excel; SAS / Access; Analysis;

Medical Insurance
Dental Insurance
Vision Insurance
Life Insurance
Short Term / Long Term Disability
Tuition Assistance
401 (k) - employer matched