Provider Network Operations Data Analyst
- Remote – The associate can work remotely from anywhere in the Detroit Metro area, Michigan, and must be able to attend two weeks of in-office training at our Southfield, Michigan, location.
- Serve as a primary point of contact for providers, ensuring timely resolution of inquiries and issues.
- Communicate plan policies, procedures, and regulatory updates clearly and professionally.
- Maintain and monitor provider data to ensure accuracy across all systems.
- Review and process provider data intake forms for completeness.
- Track and document provider data changes to ensure timely updates and compliance with turnaround standards.
- Escalate discrepancies or requests that conflict with business processes or contract terms.
- Ensure timely and accurate management of provider contracts, including terms and reimbursement details.
- Investigate and respond to member complaints within established timelines.
- Identify and report compliance issues in accordance with plan policies and procedures.
- Demonstrate working knowledge of provider databases (e.g., Facets) and reimbursement methodologies.
- Collaborate with internal departments to manage medical costs and support strategic initiatives.
- Demonstrates working knowledge of Facets, particularly the provider database, and consistently communicates updates, such as additions, deletions, or corrections, to the provider maintenance department.
- Bachelor’s degree or equivalent work experience required.
- At least one year of experience working with healthcare providers and provider relations
- 3 years of experience in managed care or health insurance preferred.
- Proficiency in Microsoft Excel & Access (formulas, pivot tables, charts/graphs).
- Strong analytical skills (non-IT focused)
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