Provider Network Reporting Analyst

Provider Network Reporting Analyst – (2400343)

Description

The Provider Network Reporting Analyst position allows you the flexibility to work at home as long as you reside within a 50-mile radius of the Brooklyn, OH Medical Mutual office.

Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.6 million Ohioans through our high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement and individual plans.

Medical Mutual’ s status as a mutual company means we are owned by our policyholders, not stockholders, so we don’t answer to Wall Street analysts or pay dividends to investors. Instead, we focus on developing products and services that allow us to better serve our customers and the communities around us and help our members achieve their best possible health and quality of life.

Working under general supervision, develops custom provider network reports in response to requests from provider contracting and sales. Provides analytical support during the sales process for network provider geographic availability and disruption analyses and Request for Proposal (RFP). Ensures data integrity and up to date information in provider databases and technical documentation.

Responsibilities

Provider Network Reporting Analyst II

• Receives network reporting requests from provider contracting and sales. Assesses and interprets customer needs and requirements. Develops, modifies, maintains and delivers routine to complex custom reports from multiple data sources.
• Interprets data and analyzes results for Request for Proposal (RFP). Collaborates with sales proposal unit to understand requirements and deliver beneficial requested information.
• Analyzes network provider geographic availability and disruption. Compares and summarizes the customer group’s current network to the Company’s and other networks sources. Reports on network adequacy and accessibility, plotting proximity of providers to homes of members in customer group.
• Ensures data integrity of provider databases. Conducts data scrubs and organizes data to maximize opportunities for specialty analyses and improve quality of data.
• Acquires and incorporates external data from other network sources the Company uses to maintain up to date databases.
• Ensures technical documentation is up to date for various systems, services and business policies and processes, including databases and reporting procedures. Makes recommendations for process improvements.
• Maintains relationship with contracting and sales to understand ongoing reporting needs. Keeps up to date on Company products and services, internal movements, industry trends, regulations and related and determines impact to business processes.
• Performs other duties as assigned.

Sr. Provider Network Reporting Analyst

• Receives reporting requests from internal customers. Assesses and interprets customer needs and requirements. Collaborates with internal customers to produce requirements when necessary. Independently develops, modifies, maintains, and delivers routine to complex custom reports from multiple data sources.
• Leads cross-functional teams to evaluate quality, recommend process improvements and establish reporting standards.
• In support of group sales opportunities, analyzes employer group claims history to project network disruption. Using group census, reports on network adequacy and accessibility, plotting proximity of providers to homes of members in a customer group.
• In support of network development, NCQA, CMS and ACA requirements, report on network adequacy and accessibility, plotting proximity of providers to homes of members.
• Provides coaching and mentoring to more junior Analysts including facilitating knowledge transfer and advance staff development.
• Develops, modifies, and delivers provider network related RFP responses and contractual guarantee data.
• Maintains relationship with internal and external customers and vendors to understand ongoing reporting needs. Recommends solutions to reporting needs. Keeps up to date on Company products and services, internal movements, industry trends, regulations and related and determines impact to business processes.
• Ensures technical documentation is up to date for various systems, services and business policies and processes, including databases and reporting procedures. Uses best practices and knowledge of internal or external business issues to improve services and processes. 
• Performs other duties as assigned.

Qualifications

Qualifications

Provider Network Reporting Analyst II

Education and Experience:

• Bachelor’s degree in Business Administration, Statistics or related field or equivalent combination of training/education and experience.
• 2 years’ experience as a Provider Network Reporting Analyst or equivalent experience in health insurance provider operations/data management. 

Technical Skills and Knowledge:

• Understanding of file structures, data definitions and relationships across all files.
• Knowledge of provider data structure, including tax ID, demographics, etc.
• Knowledge of systems applications and implementations.
• Intermediate to advanced Microsoft Office skills including spreadsheet and database reporting. Ability to create and analyze diverse sets of business data using Excel, Access, SQL, SSRS, QMF, Crystal Reports.
• Ability to identify and investigate thematic trends in data.

Sr. Provider Network Reporting Analyst

Education and Experience:

• Bachelor’s degree in business or healthcare administration, data analytics, health information systems, or related field. In lieu of degree, may consider equivalent combination of training/education and experience.
• 5-6 years of experience as a Provider Network Reporting Analyst or equivalent experience in data analysis and reporting, preferably in provider network operations. 

Technical Skills and Knowledge:

• Advanced Microsoft Office skills, especially Excel and Access and provider database maintenance and reporting skills. 
• Ability to create and analyze diverse sets of business data using one or more of the following software: SQL, SSRS, QMF, Crystal Reports, SAS, Tableau, Power BI, Python, DBeaver.
• In-depth knowledge of provider data structure, including tax ID, demographics, etc.
• Ability to identify and investigate trends in data.
• Ability to provide peer review and/or training.

Medical Mutual is looking to grow our team! We truly value and respect the talents and abilities of all of our employees. That’s why we offer an exceptional package that includes:

A Great Place to Work:

• We will provide the equipment you need for this role, including a laptop, monitors, keyboard, mouse and headset.
• Whether you are working remote or in the office, employees have access to on-site fitness centers at many locations, or a gym membership reimbursement when there is no Medical Mutual facility available. Enjoy the use of weights, cardio machines, locker rooms, classes and more.
• On-site cafeteria, serving hot breakfast and lunch, at the Brooklyn, OH headquarters.
• Discounts at many places in and around town, just for being a Medical Mutual team member.
• The opportunity to earn cash rewards for shopping with our customers.
• Business casual attire, including jeans.

Excellent Benefits and Compensation:

• Employee bonus program.
• 401(k) with company match up to 4% and an additional company contribution.
• Health Savings Account with a company matching contribution.
• Excellent medical, dental, vision, life and disability insurance — insurance is what we do best, and we make affordable coverage for our team a priority.
• Access to an Employee Assistance Program, which includes professional counseling, personal and professional coaching, self-help resources and assistance with work/life benefits.
• Company holidays and up to 16 PTO days during the first year of employment with options to carry over unused PTO time.
• After 120 days of service, parental leave for eligible employees who become parents through maternity, paternity or adoption.

An Investment in You:

• Career development programs and classes.
• Mentoring and coaching to help you advance in your career.
• Tuition reimbursement up to $5,250 per year, the IRS maximum.
• Diverse, inclusive and welcoming culture with Business Resource Groups.

About Medical Mutual:

Medical Mutual’s status as a mutual company means we are owned by our policyholders, not stockholders, so we don’t answer to Wall Street analysts or pay dividends to investors. Instead, we focus on developing products and services that allow us to better serve our customers and the communities around us.

There’s a good chance you already know many of our Medical Mutual customers. As the official insurer of everything you love, we are trusted by businesses and nonprofit organizations throughout Ohio to provide high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement and individual plans. Our plans provide peace of mind to more than 1.2 million Ohioans.

We’re not just one of the largest health insurance companies based in Ohio, we’re also the longest running. Founded in 1934, we’re proud of our rich history with the communities where we live and work.

At Medical Mutual and its family of companies we celebrate differences and are mutually invested in our employees and our community. We are proud to be an Equal Employment Opportunity and Affirmative Action Employer. Qualified applicants will receive consideration for employment regardless of race, color, religion, sex, sexual orientation, gender perception or identity, national origin, age, marital status, veteran status, or disability status.

We maintain a drug-free workplace and perform pre-employment substance abuse and nicotine testing.

Primary Location

: US-OH-Brooklyn

Work Locations

: 

Brooklyn 

100 American Road 

Brooklyn 44144

Job

: 7 – General Staff

Organization

: Provider Support

Schedule

: Regular

Shift

: Standard

Job Type

: Full-time

Day Job

Job Posting

: Jul 18, 2024, 3:23:52 PM

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