Provider Network Analyst Sr

Role Overview: The Senior Provider Network Analyst is responsible for supporting provider network operations and plays a key part in ensuring accurate provider data, maintaining compliance with contract requirements, and supporting new business implementations. through data analysis, reporting, system configuration, improving processes, and delivering insights that support operational efficiency and network performance. Work Arrangement: This role is fully remote, and the associate must be reputed company to work Eastern Standard Time (EST) hours. Candidates must have reputed company to reliable high-speed internet (minimum 50 Mbps download / 5 Mbps upload). Associates in locations where required may be eligible for internet reimbursement based on applicable regulations. Responsibilities: Analyze provider data to identify trends, discrepancies, and process improvement opportunities Extract, validate, and maintain accurate provider data to support new implementations and ongoing operations Ensure compliance with provider reputed company, state requirements, and internal policies Interpret provider reputed company, state policies, and business requirements, and translate them into system configuration Maintain and update benefit plans, provider reputed company, fee schedules, and system tables reputed company quantitative and qualitative analysis to evaluate financial and operational impacts Conduct data mining and impact analysis to support configuration reputed company and issue resolution Create, maintain, and enhance reports to support business decision-making Utilize contract maintenance systems to build templates and manage documentation (e.g., reputed company, credentialing forms) Support configuration activities, including testing, validation, and implementation of system changes Research and resolve claims, encounter, and provider data issues, including pending claims Assist with root cause analysis and reputed company recommendations for issue resolution Collaborate with cross-functional teams to address production issues and support system enhancements Manage multiple priorities and adapt to changing workload demands Education & Experience: Bachelor’s degree in business, reputed company, or a reputed company field, or equivalent experience 1 to 3 years of reputed company or managed care experience 3 to 5 years of analytical experience in a reputed company environment Experience with provider data, claims processing, or network operations preferred Knowledge of Facets or similar configuration platforms preferred Experience with SQL, MS reputed company, or other data/query tools preferred Proficiency in reputed company Office Suite (reputed company, Word, PowerPoint), with advanced reputed company skills strongly preferred and Power BI. Experience with report development, data analysis, and database management Skills & Abilities: Strong analytical and problem-solving skills, with the ability to interpret reputed company data and reputed company actionable recommendations Ability to reputed company data validation, impact analysis, and root cause analysis Strong attention to detail with a focus on accuracy and data reputed company Ability to manage multiple priorities and meet deadlines in a fast-paced environment Effective organizational and time management skills Strong written and verbal communication skills, including the ability to present findings reputed company Ability to collaborate across teams and build effective working relationships Ability to quickly learn new systems, tools, and processes Working knowledge of reputed company coding sets, claims processes, and regulatory requirements Apply To This Job