Job Location: Pune
What You’ll Be Doing:
Evolent Health is looking for a Provider Data Analyst to be a key member of the Louisville Medicare Advantage Operations team. Reporting to the Director of Provider Data Management, this individual will play a critical role in executing Evolent Health’s mission by working directly with our partners, focused on coordinating, monitoring, trending and supporting report requirements of business operational and clinical programs within Provider Network Management. This Provider Data Analyst will work with both internal and external business partners to implement ongoing operational monitoring, resolve service barriers, develop solutions to improve effectiveness and identify continuous improvement initiatives to increase service levels.
Essential functions:Serve as a liaison between TPA/BPO partner, internal team members and partner organization providing supervisory leadership for provider data enrollment activities; acts as liaison with technology team and business product team membersDefines analysis methodology and provides analytic supportAnalyzes existing systems to recommend enhancements and creates new systems to reduce manual processes and maximize the business efficienciesAnalyzes data from conceptualization through presentation and requires proficiency with analytical tools, knowledge of data analysis methodology, use of presentation software, and strong communication skillsIdentifies, evaluates, and implements new data-driven strategies and processes for the department
Develops tools and reports that lend valuable insights that capitalize on a combination of internal and external dataRecommends enhancements to existing systems in accordance to business needs by creating ad hoc and standard reports as well as information delivery technologiesPrepare reports in an accurate, concise and timely fashionPerforms data collection, analysis, reportingProvide guidance and support to all claims and operations personnel towards resolution of provider data and claims problems with an emphasis on root cause analysis and resolution of problems
Compile, review and analyze management reports and take appropriate actionIdentify and advise Claims, Provider Network Management, Medicare Operations and other operational areas of trends, problems, and issues as well as recommended course of action; ensure timely communication; participate in the development and implementation of solutionsMonitor adherence to the efficiency and service level goals including volume, processing, timeliness, accuracy and other metrics.Compose, submit and track claim system questions and configuration requests to correct identified systemic issues
Prioritize issues identified by TPA/BPO, internal team members and/or partner representatives and monitors progress in the resolution of the issuesDevelop deep understanding of processing capabilities and limitations of claims and benefits with TPA/BPO systems, tools and resources; provide recommendations to meet plan requirements
Confirm that all provider data elements have been set up within the claims payment system and are aligned with the requirements as specified by the plan materialsCreate and report operational tracking metrics and dashboards for monitoring claims, provider disputes and benefits performance
Coordinate corrective action plans with partner/client and TPA/BPO operations services administrator to resolve issuesSupport internal plan team members with the resolution of daily issues
Work with other departments to identify and resolve problems leading to incorrect provider data and issues regarding payment of claimsServe on various committees and attends required meetings.Able to commute up to 15% to Evolent offices.Perform other duties and projects as assigned
Key competencies/skill/success factors:Experience working within a health plan, managed care organization, provider operated healthcare environment or third party administratorExtensive knowledge of PCs and related software applications, such as Word, PowerPoint, Excel, Project
Demonstrated exceptional active listening and communications skillsExperience in systems and languages related to database lifecycle management such as MS Access, SQL Server, Visual Basic, et
Qualification and Experience:Required
Associates Degree or equivalent 2-4 years of experience in collecting, analyzing, and presenting data and recommendations to managementBig plus
Bachelor’s degree in Computer Science, Statistics, Mathematics or related field
1-3 years data analysis and business intelligence experience working with BI suites such as Qlikview, SSRS, Tableau or other enterprise class toolsPrior supervisory or team lead experienceExperience with Medicare Advantage plan
Technical requirements:Currently, Evolent employees work remotely temporarily due to COVID-19. As such, we require that all employees have the following technical capability at their home: High speed internet over 10 MBPS and, specifically for all call center employees, the ability to plug in directly to the home internet router. These at-home technical requirements are subject to change with any scheduled re-opening of our office locations.
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