Provider Data Operations Analyst II - Analytics & Quality

caresource; United States; Remote; USD 63,000 - 100,000; Full time

Job summary

CareSource in the United States is seeking a Provider Operations Analyst II responsible for translating large, complex provider data into actionable insights and tracking metrics.

You will develop queries to identify data issues, support contracting, credentialing, directories, and pended claims, act as SME/BA/DA on initiatives, collaborate across teams, and help ensure data quality and regulatory compliance.

Qualifications

• Bachelor's degree or equivalent years of relevant work experience.
• Minimum of 3 years in health care or managed care.
• Experience with claims systems, preferably Facets.
• Experience in provider relations, contracting, onboarding or credentialing is highly preferred.

Responsibilities

• Develop queries to identify provider data issues and plan resolutions.
• Provide analysis and oversight for provider data workflows across teams.
• Act as SME/BA/DA for Provider Operations on initiatives.
• Collaborate across Claims, Configuration, and Market Reps to integrate processes.
• Identify and implement reporting to ensure data quality and compliance.
• Develop and monitor daily staff performance metrics.
• Lead root cause analyses for high-level escalations.
• Manage special projects with high-dollar or compliance risk.

Skills

SQL/Access

Advanced Excel

PowerPoint

Word

Analytical thinking

Communication skills

Education

Bachelor's Degree or equivalent years of relevant work experience

3 years health care/managed care experience

Tools

Facets

Choreo/Contract Manager

Cactus

Job description

CareSource in the United States is seeking a Provider Operations Analyst II responsible for translating large, complex provider data into actionable insights and tracking metrics.

You will develop queries to identify data issues, support contracting, credentialing, directories, and pended claims, act as SME/BA/DA on initiatives, collaborate across teams, and help ensure data quality and regulatory compliance.