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Data Analyst
  • SQL
  • Data Analysis
  • Excel
  • Database
Prospect Medical Systems
Orange, CA 92868
124 days ago

Data Analyst - Credentialing Department

We are hospitals and affiliated medical groups, working closely together for the benefit of every person who comes to us for care. We build comprehensive networks of quality healthcare services that are designed to offer our patients highly coordinated, personalized care and help them live healthier lives. Through collaboration, we strive to provide all of our patients and medical group members with the quality, affordable healthcare they need and deserve.

The Data Analyst is responsible for designing, developing, and maintaining datasets to support business requirements of the team, and continually improve data acquisition and reporting methods. This includes periodically reviewing the databases to enhance the processes and functionalities. The incumbent is responsible for assisting with the development of internal systems and exception reports to ensure timely and accurate credentialing and provider information data and reports.

Job Responsibilities/Duties

  • Design process and reports for Credentialing and PIM teams in order to support business requirements.
  • The incumbent will be responsible for periodically reviewing system database(s) to enhance the process and functionalities.
  • Provide guidance, development and training of staff utilizing these systems.
  • Identify, develop, and implement process improvements in data quality & reporting
  • Ongoing reviews of data quality/integrity.
  • Prepare CMS/DHCS audit universe datasets.
  • Prepare daily/weekly/monthly oversight data reports for review.
  • Perform regular reporting functions and assist the team with ad-hoc report requirements
  • Provide expertise in data analysis, including provider demographics, credentialing and other related data elements.
  • Act as the point of contact for data requests and assign requests as appropriate and monitor timeliness and outcomes.
  • Assists the team with special projects including data load for new business
  • Coordinate with the third-party vendor to ensure data is transmitted and received using the correct file and data format/layout.
  • Create and maintain formats for all department report templates. Work with IT and other stakeholders to create/modify templates as needed based on business needs.
  • Monitor communication from internal and external sources to identify changes in requirements (from HP or Regulatory or Internal business needs)

Qualifications

Minimum Education: Bachelor’s degree in Health Care Administration, Business Administration, Mathematics or other related field.

Minimum Experience: 5 -7 years as a Data Analyst that provides the knowledge and abilities listed above. Minimum of 5 years of HMO/IPA experience in Provider enrollment, Network Management or Contracting. IPA Operations experience strongly recommended. Proficiency in word (Advanced), excel (Advanced), pivot tables (Advanced), SQL (Intermediate), Microsoft access (Basic – Intermediate), Other Office suites (Intermediate) and SharePoint (intermediate) preferred. Experience in an IPA, hospital or health plan setting is preferred. Experience with managed health care programs is preferred. Initiate and follow-through on projects with little supervision or guidance. Work independently as well as cooperatively and effectively on group projects, under minimal supervision and with multiple deadlines. Develop and maintain effective working relationships with all levels of staff, other departments (i.e. IS), and various external customers. Present information in a useable format and be able to clearly explain content. Strong proficiency in spreadsheets, word processing and database software programs; work with complex databases. Meet and maintain established quality standards. Work with complex databases, build queries, reports, format reports, and export reports. MS Access to create ad-hoc reports and design databases, strong competence with the process of data retrieval from data warehouses and databases. Microsoft Excel to manipulate data and produce charts/reports applicable to reporting requests. Excellent organizational skills and the ability to prioritize tasks and use time efficiently. Senior-level data quality assessment and analysis skills. Strong verbal and written communication skills. Working knowledge of Managed care concepts. SQL, VBA and ANSI 837 knowledge preferred.

Req. Certification/Licensure: None.

Employee Value Proposition

Prospect Medical Holdings, Inc., is guided by a diverse and highly experienced leadership core. This group maintains the vision that has made Prospect a needed difference-maker in the lives of so many patients today, and many executives contribute to our continued efforts. As a member of our highly effective team of professionals you will receive:

  • Company 401K
  • Medical, dental, vision insurance
  • Paid time-off
  • Life insurance

How to Apply

To apply for this role, or search our other openings, please visit http://pmh.com/careers/ and click on a location to begin your journey to a new career with us!

We are an Equal Opportunity/ Affirmative Action Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation or other protected characteristics. If you need special accommodation for the application process, please contact Human Resources.

EEOC is the Law: https://www1.eeoc.gov/employers/poster.cfm

Keywords: Data Analyst, IPA, Health Plans, Hospitals, Network Management, Contracting, SQL, Advanced Excel, Reporting

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