[Hiring] Provider Network Data Integrity Analyst @Sanford Health

Role Description

This position is responsible for the accuracy, completeness, and required regulatory filings of the Health Plan’s (HP) provider network. Serves as a resource for strategic planning, compliance, and network analysis. Responsible for completion of network adequacy filings for:

• Centers for Medicare and Medicaid Services (CMS)
• National Committee for Quality Assurance (NCQA)
• Department of Health Services (DHS)
• Requested employer groups

Accountable for the maintenance, enhancements, and overall data integrity to ensure the Health Plan’s provider directory meets established CMS standards.

Key responsibilities include:

• Developing and enforcing data quality standards within the provider and facility database.
• Completing network adequacy reviews in collaboration with the Health Plan's Business Intelligence Department representatives.
• Performing analyses and audits to identify gaps in current provider networks.
• Coordinating required regulatory provider network submissions.
• Auditing and advising provider credentialing on identified data issues.
• Maintaining accurate data in HP Provider Directory to ensure compliance with CMS, DHS, and Office of the Commissioner of Insurance requirements.
• Organizing a large amount of data into easy-to-understand formats for strategic planning.
• Maintaining a strong understanding of providers and facilities in current HP's service area.
• Researching and communicating regulatory directives.
• Performing disruption analysis for potential customers of HP.
• Other duties as assigned.

Qualifications

• Bachelor’s Degree in business administration, finance, healthcare related field, computer science, or analytics.
• Successful completion of a post-secondary medical terminology course preferred.
• 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.
• Understanding of geoaccess coding, provider credentialing, and medical terminology preferred.

Company Description

Sanford Health, the largest rural health system in the United States, is dedicated to transforming the health care experience and providing access to world-class health care in America’s heartland.