Provider Data Analyst and Auditor

Community Health Group; Chula Vista (CA); On-site; USD 37,000 - 41,000; Full time

Job summary

Community Health Group currently seeks a Provider Directory & Data Integrity Analyst to ensure accurate contract information is entered into Symplr with alignment to QNXT. The role supports the Provider Directory compilation and oversees daily Committee Finals, in a compliance-focused environment.

Two years of related experience or equivalent education is required, with knowledge of Vistar and QNXT databases. Occasional travel within San Diego County is expected.

Qualifications

• 2 years’ work experience or equivalent education.
• Knowledge of Vistar and QNXT databases.
• Proficient in word processing and database management.
• Strong analytical and problem-solving skills.
• Thorough, accurate and detail oriented.

Responsibilities

• Develop operations procedures by coordinating provider information internally through contract development and claims submission, and externally through survey or direct contact with network providers.
• Determines contracts to be assigned to providers by reviewing contract language.
• Maintains, produces and distributes network provider directories for all plan types by updating provider site listings and creating database queries.
• Inform all affected departments of updated information by meetings or routing notices.
• Understand credentialing information to ensure QNXT data matches provider credentials.
• Produce reports, labels and directories in a timely manner; maintain policies and procedures; participate in educational programs and meetings.
• Backup support in the area of the Provider Directory compilation.
• Occasional travel within the San Diego County area.
• Maintain review, monitoring and auditing of daily Committee Finals.

Skills

Vistar

QNXT

Word processing

Database management

Analytical skills

Detail oriented

Communication

Education

AA Degree or equivalent

Job description

Job Details

Job Location: Corporate Headquarters - Chula Vista, CA 91914

Position Type: Full Time

Salary Range: $26.96 - $29.65 Hourly

POSITION SUMMARY

Provides advanced analytical techniques to ensure accurate contract information is applied for data entry into Symplr with correlation to QNXT system. Ensures companies maintain high standards and compliance with regulatory requirements by maintaining effective multi-departmental improvement databases, which integrates and coordinates results of all assessment/evaluation activities, problem identification and resolution activities. Responsible for accurate written and electronic provider directories. Responsible for providing support in the area of the Provider Directory compilation.

Responsible for reviewing, monitoring and auditing the department’s daily Committee Finals.

COMPLIANCE WITH REGULATIONS

Works closely with all departments necessary to ensure that the processes, programs and services are accomplished in a timely and efficient manner in accordance with CHG policies and procedures and in compliance with applicable state and federal regulations including DHCS, DMHC, CMS and/or Medicare Part D and Special Needs Plan (SNP).

RESPONSIBILITIES

• Develop operations procedures by coordinating the gathering of provider information internally through contract development and claims submission, and externally through survey or by direct contact with network providers.
• Determines contracts to be assigned to providers by reviewing contract language.
• Maintains, produces and distributes network provider directories for all plan types by updating and maintaining provider site listings, creating database queries to produce accurate primary care site listings and hospital, specialty and ancillary referral panels.
• Inform all affected departments of updated information by meetings with or by routing notices through inter-company mail and e-mail to appropriate staff in Operations Claims, Health Care Services, Financial Services and Information Systems Divisions.
• Understand credentialing information (license types, provider types, & scope of practice) so data entry of QNXT will match provider’s credentials and scope of practice.
• Provides information as requested and contributes to the team effort by producing reports, labels and directories in a timely manner; maintaining established departmental policies and procedures, objectives, safety and environmental control standards; enhancing professional growth and development through participation in educational programs, current literature, in-service meetings and workshops; attending meetings as required and participating on committees as directed; working closely with Operations Claims and , Information Systems; and performing other related duties as assigned or requested.
• Maintains product and company reputation and contributes to the team effort by conveying professional image and accomplishing related tasks.
• Will need to provide backup support in the area of the Provider Directory compilation.
• This position requires occasional travel within the San Diego County area.
• Maintain the review, monitoring and auditing of the department’s daily Committee Finals.

QualificationsEDUCATION

• Associate of Arts Degree or equivalent work experience

EXPERIENCE/SKILLS

• 2 years’ work experience or minimum education.
• Ability to operate a personal computer, fax and copier.
• Knowledge of Vistar and QNXT databases.
• Proficient in word processing and database management applications.
• Strong problem solving and analytical skills.
• Thorough, accurate and detail oriented.
• Ability to establish and maintain rapport with staff at all levels in problem resolution and development of reports and procedures.

PHYSICAL REQUIREMENTS

• May be required to work evenings and/or weekends.

The above statements are intended to describe the general nature and level of work being performed. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of personnel so classified.

All qualified applicants will receive consideration for employment based on merit, without regard to race, color, religion, sex, national origin, disability, protected Veteran Status, or any other characteristic protected by applicable federal, state, or local law.