Provider Network Data Integrity Analyst - Health Plan
$49,920–$80,080 year
Remote · Wisconsin, United States or US
Job Summary
Provider Network Data Integrity Analyst responsible for the accuracy, completeness, and regulatory filings of the Health Plan’s provider network. Develops and enforces data quality standards within the provider and facility database to ensure credentialing data is current. Performs network adequacy reviews per CMS/NCQA/DHS, coordinates regulatory submissions, and maintains the provider directory in compliance with CMS, DHS, and insurance requirements. Conducts analyses to identify gaps, audits data issues with credentialing entities, and supports strategic planning and bidding efforts. Requires a Bachelor’s degree and 3 years of experience in healthcare settings; proficient with Excel and Access; knowledge of geoaccess coding and credentialing is preferred.
Required Qualifications
- Bachelor’s Degree in business administration, finance, healthcare related field, computer science, or analytics.
- 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 to include Excel and Access.
- Understanding of geoaccess coding, provider credentialing, and medical terminology preferred.
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