Kaiser Permanente Analyst, Provider Data Management in Atlanta, Georgia
Supports department goals by maintaining all network provider data received from business units. Conducts audits and analysis in accordance with provider contracts, claims, and regulatory requirements while using experience with data extracts, manipulation and/or data management. Designs, coordinates, and produces reporting required for internal and external stakeholders and regulatory agencies. Provides recommendations on process or system improvements, communicates with key stakeholders with regard to research requests and general inquiries.
Maintains provider systems with accurate and up-to-date information for external/affiliated providers while displaying analytical and problem-solving ability. Conducts audits and analysis in accordance with provider contracts, claims, and regulatory requirements while using experience with data extracts, manipulation and/or data management.
Creates, researches and sends ad hoc and monthly reports to business partners including but not limited to, network adequacy, provider directory, provider participation and marketplace.
Performs intermediate spreadsheet analyses and database solutions using tools such as Cactus and Excel; develops scorecard reporting and provides basic statistical measurement interpretation.
Researches and responds to inquiries from business units and stakeholders.
Performs other duties as assigned.
Minimum four (4) years of provider contracting, provider data and health care operations experience which includes data analyses.
Minimum four (4) years of healthcare claims experience in regards to how provider data affects payments/processing and regulatory agency audits.
Bachelor's degree in business, health care or related field or four (4) years of experience in a directly related field.
High School Diploma or General Education Development (GED) required.
License, Certification, Registration
Strong proficiency in Microsoft Office applications.
Strong analytical and problem-solving skills.
Motivated to acquire new skills and knowledge for improved performance while working under pressure.
Strong work ethic and completes tasks in a timely and efficient manner.
Effective and clear communication using appropriate channels to maintain working relationships.
Strong ability to meet aggressive deadlines.
Understanding of health plan products such as HMO, PPO, Medicare, etc.
Progressive experience with data extracts, manipulation and/or data management.
Extensive experience in provider data management and system analysis.
Kaiser Permanente is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, sexual orientation, national origin, marital status, parental status, ancestry, disability, gender identity, veteran status, genetic information, other distinguishing characteristics of diversity and inclusion, or any other protected status.
External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with federal and state laws, as well as applicable local ordinances, including but not limited to the San Francisco and Los Angeles Fair Chance Ordinances.
TITLE: Analyst, Provider Data Management
LOCATION: Atlanta, Georgia
External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.
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