Provider Analyst

  • Network Management
  • Fort Lauderdale
  • 7 months ago
  • 2 available

Job Description

Responsible for analytical review of provider network performance for active, as well as, prospective Clients.  Develop and maintain a close working relationship with the internal departments for implementation and operation of new and current Client contracts

Essential Functions & Responsibilities

  • This position requires strong analytical skills to thrive in a fast paced environment as well as be comfortable with management exposure.
  • Analyze the claims utilization and cost performance of the specialty networks.
  • Analyze the claims utilization data provided by prospective Clients.
  • Review network accessibility (including quarterly geo-map analysis).
  • Complete cost and quality metrics and report outcome to senior management and other departmental staff.
  • Network oversight of adjudication of Claims by TPA.
  • Maintain strong working relationships with Network Managers, acting as their key support in reviewing provider network performance.
  • Provide tactical support and recommendations to network contracting team by assisting with analyses, projects, etc. Supports negotiation and contract interpretation and compliance.
  • Act as a liaison between Networks and TPA departments for assistance and operations of contractual obligations of Networks to its Clients.
  • Work on various special projects and ad-hoc reports on an as needed basis.
  • Develop and maintain familiarity with the managed care industry, such as availability of outside sources of information, statutes affecting HN1 business, current industry trends, and general services/locations of major non-contracted providers.
  • Attend all staff and committee meetings as requested by the Vice President of Network Operations and/or President  & COO, including evening quarterly Executive Committee Meeting.

Required Education and Experience

  • Bachelor's degree or equivalent data analysis experience.
  • Two or three years background in the managed care industry.
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Date Posted:

Apr 25, 2023


Fort Lauderdale

Job Title

Provider Analyst


Network Management


40h / week

  • Primary industry: Healthcare
  • Company size: 250 - 300
  • Founded in: 1999
  • Phone: 1-800-595-9631
  • Headquarter: Fort Lauderdale, FL
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