Provider Network Operations Analyst

Gold Coast Health Plan will not sponsor applicants for work visas.
The pay range above represents the minimum and maximum rate for this position in California. Factors that may be used to determine where newly hired employees will be placed in the pay range include the employee specific skills and qualifications, relevant years of experience and comparison to other employees already in this role. Most often, a newly hired employee will be placed below the midpoint of the range. Salary range will vary for remote positions outside of California.
POSITION SUMMARY
The Analyst, Provider Network Operations will analyze the providers in a network and the utilization by members and is responsible for preparing and analyzing various standard and ad hoc reports as well as decision support tools for management. Position is responsible for running reports to ensure that Gold Coast Health Plan (Plan) is compliant with the Department of Health Care Services (DHCS) and other regulatory agencies, and is responsible for analyzing, developing, and implementing database designs, data models and relational database definitions across multiple computing environments under general supervision.
Interacts with various departments to ensure integrity of data entered in systems and/or databases, and ensures data is maintained and used appropriately throughout Plan. The position is also responsible for supporting Provider Network Operations with assigned projects, development of policies, procedures and workflows, systems management, and organization.
ESSENTIAL FUNCTIONS
Reasonable Accommodations Statement
To accomplish this job successfully, an individual must be able to perform, with or without reasonable accommodation, each essential function satisfactorily. Reasonable accommodations may be made to help enable qualified individuals with disabilities to perform the essential functions.
Essential Functions Statement(s)
• This position requires strong analytical skills to thrive in a fast-paced environment as well as be comfortable with management exposure.
• Lead Provider Network Operations in completing monthly, quarterly, annual and ad-hoc reporting for business and regulatory requirements and deliverables.
• Identify, analyze, and interpret trends or patterns for methods to better benefit the Plan.
• Develop and maintain databases necessary for projects and department functions.
• Uses analytical and data skills to produce reports to support the Business in making data driven business decisions.
• Interpret and utilize project results to develop graphs, dashboards, ad hoc and regularly scheduled reports, and presentations.
• Perform basic statistical analyses for projects and reports.
• Extract and analyze data from various sources to perform rate analysis and develop cost saving programs for the Plan.
• Assist in the development and management of performance-based provider payments.
• Generate routine and ad hoc reports as assigned.
• Assist department in annual audits of Plan.
• Perform Provider Network analysis, trending reports and provider access data.
• Facilitates provider satisfaction surveys as related to how they affect provider satisfaction.
• Maintains an up to date and thorough knowledge of Gold Coast Health Plan's policies as related to provider contracting and operations.
• Conducts accurate research to resolve issues regarding, claims and contracting using appropriate systems.
• Properly documents all calls/contacts as required by department standards in a clear and concise manner.
• Communicates complex issues effectively to both internal and external business associates.
• Supports Manager, Provider Contracting & Regulatory.
POSITION QUALIFICATIONS
Competency Statement(s)
• Analytical Skills – systemic and logical approach to problem solving. Must also have ability to identify critical issues quickly and navigate priorities based on last minute changes.
• Technical Aptitude - Ability to comprehend and learn complex technical topics, software, and specialized information.
• Organization – well organized, detail oriented and have strong time management skills
• Business Acumen - Ability to grasp and understand business concepts and issues and have strong written and verbal communication skills
• Presentation Skills - Ability to effectively present information publicly and train others.
• Customer Oriented - Ability to take care of the customers’ needs while following company procedures.
• Relationship Building - Ability to work successfully in a team environment and build effective relationships with internal and external customers.
• Flexibility/adaptability – be agile as this position has a range of responsibilities and will grow with the department’s growth. Also display a positive and approachable personality.
• Diversity Oriented - Ability to work effectively with people regardless of their age, gender, race, ethnicity, religion, or job type.
SKILLS & ABILITIES
Education:
• Bachelor's Degree (four year college or technical school) Required, Field of Study: Information Management Systems, Finance/Accounting, Healthcare Information.
• Or Bachelor's Degree in related fields: Business, Computing, Mathematics, Statistics, or related technical/analytical fields. Preferred.
Experience:
• Previous data analyst experience.
• Managed Care or Healthcare background or experience a plus.
Computer Skills: Proficient in MS Word, Excel pivot tables and Vlook ups, Access, PowerPoint and Visio. Knowledge of SQL, project management software and GEOmaps.
Certifications & Licenses: A valid California Driver's License and insurance.
Other Requirements:
• Technical expertise regarding data models and database design development.
• Adept at queries and report writing.
• Strong business analysis, mathematical, statistical, and data analysis skills. Research, analytical, organization, and time/project management skills required. Knowledge of statistics, to the degree one can discuss with statisticians.
• Excellent analytical ability, judgment and problem solving.
• Ability to present complex information in an understandable and compelling manner. Communicate effectively in both verbal and written form.
• Professionalism - Approaches others in a tactful manner; reacts well under pressure; treats others with respect and consideration regardless of their status or position; accepts responsibility for own actions; follows through on commitments.