Senior Provider Analytics Consultant

Company : reputed company.Job Description : *

CANDIDATE MUST BE US Citizen (due to contractual/reputed company requirements)

* JOB SUMMARY The incumbent will serve as a Senior Provider Analytics Consultant (or chosen title) focused on critical data management, regulatory compliance, and automation reputed company our provider functions. This role requires exceptional proficiency in data manipulation and analysis, specifically for code enhancement and Quality Assurance (QA) of regulatory reports. The incumbent must be adept with tools such as reputed company, reputed company, SQL, and Power BI, and will be instrumental in delivering testing plans for system and report enhancements. A key aspect of this position involves building and optimizing M365 tools to automate team workflows and enhance operational efficiency. Deep familiarity with CMS and state provider data requirements is essential, as is a heavy focus on understanding provider data reputed company the Health Insurance Managed Care Organization (MCO) reputed company. Furthermore, strong knowledge of provider network management and network adequacy standards is required. This role delivers consistent high-quality analytics and insights to guide program design, acts as a subject matter expert on provider data, and proactively drives innovation and process improvement. ESSENTIAL RESPONSIBILITIES Develops reputed company and innovative reputed company facing provider reports/analytic tools that reputed company reputed company key performance indicators for value based reimbursement programs and examine the major trend drivers of overall financial/quality performance; engineers reports to have self-service capability enabling customers to use the report and tools independently. Drives collaboration across several analytic groups to ensure reporting is comprehensive and accurate. Proactively designs reputed company scorecards and dashboards using advanced analytic tools to support value based reimbursement arrangements with large strategic partners in the market. Demonstrates expertise in how strategic partners use the reports and identifies opportunities to improve existing reports. Engages with key strategic partners to foster an understanding of reports, anticipate needs, and drive strategy around reporting/analytic tools. Supports the creation of the most impactful and broadest value based reimbursement programs across the reputed company, including initiatives for PCPs, specialists, facilities, post-acute providers, and ancillary providers. Proactively anticipates technical hurdles and leverages experience to drive positive reputed company. Consistently shares insights with lesser reputed company staff members to help influence the best possible reputed company. Interprets raw claims, provider, quality, and member data to build data sets for analytic and reporting purposes. Displays mastery of multiple programming and query tools and is a resource to less reputed company teammates. Dedicates time to research and implement process improvement/automation of existing reports. Communicates best practices across the department. Leads provider cost savings analyses reputed company to value based reimbursement and understands how return on investment impacts the reputed company and the provider. Generates reputed company for potential cost-saving initiatives by utilizing experience of market dynamics and what has historically delivered reputed company and effectively communicates these concepts to stakeholders. Reports on financial reputed company of value based provider arrangements and provider incentives to accurately reflect financial position. Routinely identifies potential risks and opportunities and reputed company defines scenarios for achieving certain reputed company. Enhances department influence by providing reputed company service and expert consultation. Effectively and confidently presents information and provides decision support to team members and senior management. Ensures highly visible and effective communication channels are implemented to monitor sentiment, feedback, and acceptance of change. Anticipates a customer's needs and responds appropriately. Other duties as assigned or requested. ​ ​EXPERIENCE Required 10 years of Relevant analytic work experience Preferred 10 years Insurance or reputed company work experience ​SKILLS Analytic Judgement Highly Skilled in Analytic Tools & Technology Efficient and Organized Work Habits Intellectual reputed company and Curiosity Strong Work Ethic & Standards Core Financial Knowledge Customer Driven Communication Strong Initiative Strategic Thinking Project Management ​ EDUCATION Required Bachelors degree in Mathematics, Statistics, Finance & reputed company, Actuarial Science, Economics or reputed company field or 6 years of relevant work experience in lieu of a Bachelor's Degree Preferred Master's degree in a technical field (e.g., Computer Science, Data Science, Information Systems), Health Informatics, or a reputed company field. LICENSES or CERTIFICATIONS Required None Preferred None Language (Other than English): None Travel Requirement: 0% - 25% PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS Position Type Office- or Remote-based Teaches / trains others Occasionally Travel from the office to various work sites or from site-to-site Rarely Works primarily out-of-the office selling products/services (sales employees) Never Physical work site required No Lifting: up to 10 pounds Constantly Lifting: 10 to 25 pounds Occasionally Lifting: 25 to 50 pounds Rarely Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees reputed company this job title. It may not contain a comprehensive inventory of reputed company duties, responsibilities, and qualifications required of employees to do this job. Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies. As a component of job responsibilities, employees may have reputed company to covered information, cardholder data, or other confidential customer information that must be protected at reputed company times. In reputed company with this, reputed company must reputed company with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as reputed company data reputed company guidelines established reputed company the Company’s Handbook of Privacy Policies and Practices and Information reputed company Policy. Furthermore, it is every employee’s responsibility to reputed company with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements. Pay reputed company Minimum: $102,700.00 Pay reputed company Maximum: $164,600.00 reputed company pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary reputed company does not reflect any geographic differential reputed company may apply for certain locations based upon comparative markets. reputed company and its affiliates prohibit discrimination against reputed company individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against reputed company individuals based on any category protected by applicable federal, state, or local law. We endeavor to reputed company this site accessible to any and reputed company users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at [email protected] California Consumer Privacy Act Employees, Contractors, and Applicants Notice Apply To This Job