Sr Analyst, Provider Data Management

Your Future Evolves Here

Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving force that brings us to work each day. We believe in embracing new ideas, challenging ourselves and failing forward. We respect and celebrate individual talents and team wins. We have fun while working hard and Evolenteers often make a difference working in everything from scrubs to jeans.

Are we growing? Absolutely and Globally. In 2021 we grew our teams by almost 50% and continue to grow even more in 2022. Are we recognized as a company you are supported by for your career and growth, and a great place to work? Definitely. Evolent Health International (Pune, India) has been certified as “Great Places to Work” in 2021. In 2020 and 2021 Evolent in the U.S. was both named Best Company for Women to Advance list by Parity.org and earned a perfect score on the Human Rights Campaign (HRC) Foundation’s Corporate Equality Index (CEI). This index is the nation's foremost benchmarking survey and report measuring corporate policies and practices related to LGBTQ+ workplace equality.

We recognize employees that live our values, give back to our communities each year, and are champions for bringing our whole selves to work each day. If you’re looking for a place where your work can be personally and professionally rewarding, don’t just join a company with a mission. Join a mission with a company behind it.

What You’ll Be Doing:

What You’ll Be Doing:

Evolent India is looking for a Provider Data Senior Analyst to the Supervisor 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 Senior 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 Operations, internal team members and partner organization providing supervisory leadership for provider data enrollment activities, acts as liaison with technology team and business product team members.
• Determine and document root cause analysis related to data quality errors and recommend remediation activities
• Analyzes data from conceptualization through presentation and, use of presentation software, and strong communication skills.
• Identifies, evaluates, and implements new data-driven strategies and processes for the department.
• Understands working in a health benefit administration, Third Party Administrator, or Pre-Tax Benefit environment.
• Understands and can work in a production environment in which performance is tied to operational metrics.
• Integrity and discretion to maintain confidentiality of member’s HIPAA data.
  Strong analytical ability necessary to work, discover and outline systems related issues on own as well as within a team.
• The ability to take the lead on projects and recommend and implement process to complete work.
• Proficient in MS Excel and MS Word.
• Provide 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
• Identify 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 solutions
• Monitor 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
• Develop deep understanding of processing capabilities and limitations of claims and benefits with TPA/BPO systems, tools and resources; provide recommendations to meet plan requirements
• Tracking of Operational metrics and dashboards for monitoring claims, provider disputes and benefits performance.
• Provide support to team members on accurate functionality of proprietary and supplemental data exchange platform(s) and to identify defects.
• Writes business rules and requirements that establish known or unknown deviations and responses to deviations, along with documenting concerns based on established provider data management policies and procedures.
• Work with other departments to identify and resolve problems leading to incorrect provider data.

Key competencies/skill/success factors:

Experience working within a health plan, managed care organization, provider operated healthcare environment or third party administrator.

Extensive knowledge of PCs and related software applications, such as Word, PowerPoint, Excel, Project

Demonstrated exceptional active listening and communications skills.

Experience in systems and languages related to database lifecycle management such as SQL Server, Visual Basic, etc

Qualification and Experience:

Required

Associates Degree or equivalent

4-6 years of experience in Claims, Provider/US healthcare Industry

Good in Communication

Hands on Advanced Excel.

SQL Server Experience

Big plus

Bachelor’s degree in Computer Science, Statistics, Mathematics or related field preferred.

Mandatory Requirements:

We require that all employees have the following technical capability at their home: High speed internet over 10 Mbps, 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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Evolent Health is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status.