Full Job Description
It’s Time For A Change…
Your Future Evolves Here
Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving power that brings us to work each day. We believe in embracing new ideas, testing ourselves and failing forward. We respect and celebrate individual talents and team wins. We have fun while working hard and Evolenteers often make a difference in everything from scrubs to jeans.
Are we growing? Absolutely. We have seen about 30% average growth over the last three years. Are we recognized? Definitely. We were named one of “Becker’s 150 Great Places to Work in Healthcare” in 2016, 2017, 2018 and 2019 and are proud to be recognized as a leader in driving important Diversity and Inclusion (D&I) efforts: Evolent achieved a 95% score on its first-ever submission to the Human Rights Campaign’s Corporate Equality Index; was named on the Best Companies for Women to Advance List 2020 by Parity.org; and we publish an annual Diversity and Inclusion Annual Report to share our progress on how we’re building an equitable workplace. We recognize employees that live our values, give back to our communities each year, and are champions for bringing our whole selves to work each day. If you’re looking for a place where your work can be personally and professionally rewarding, don’t just join a company with a mission. Join a mission with a company behind it.
What You’ll Be Doing:
Evolent Health is looking for a Provider Data Analyst to be a key member of the Louisville Medicare Advantage Operations team. Reporting to the Director of Provider Data Management, this individual will play a critical role in executing Evolent Health’s mission by working directly with our partners, focused on coordinating, monitoring, trending and supporting report requirements of business operational and clinical programs within Provider Network Management. This Provider Data Analyst will work with both internal and external business partners to implement ongoing operational monitoring, resolve service barriers, develop solutions to improve effectiveness and identify continuous improvement initiatives to increase service levels.
Serve as a liaison between TPA/BPO partner, internal team members and partner organization providing supervisory leadership for provider data enrollment activities; acts as liaison with technology team and business product team members
Defines analysis methodology and provides analytic support
Analyzes existing systems to recommend enhancements and creates new systems to reduce manual processes and maximize the business efficiencies
Analyzes data from conceptualization through presentation and requires proficiency with analytical tools, knowledge of data analysis methodology, use of presentation software, and strong communication skills
Identifies, evaluates, and implements new data-driven strategies and processes for the department
Develops tools and reports that lend valuable insights that capitalize on a combination of internal and external data
Recommends enhancements to existing systems in accordance to business needs by creating ad hoc and standard reports as well as information delivery technologies
Prepare reports in an accurate, concise and timely fashion
Performs data collection, analysis, reporting
Provide guidance and support to all claims and operations personnel towards resolution of provider data and claims problems with an emphasis on root cause analysis and resolution of problems
Compile, review and analyze management reports and take appropriate action
Identify and advise Claims, Provider Network Management, Medicare Operations and other operational areas of trends, problems, and issues as well as recommended course of action; ensure timely communication; participate in the development and implementation of solutions
Monitor adherence to the efficiency and service level goals including volume, processing, timeliness, accuracy and other metrics.
Compose, submit and track claim system questions and configuration requests to correct identified systemic issues
Prioritize issues identified by TPA/BPO, internal team members and/or partner representatives and monitors progress in the resolution of the issues
Develop deep understanding of processing capabilities and limitations of claims and benefits with TPA/BPO systems, tools and resources; provide recommendations to meet plan requirements
Confirm that all provider data elements have been set up within the claims payment system and are aligned with the requirements as specified by the plan materials
Create and report operational tracking metrics and dashboards for monitoring claims, provider disputes and benefits performance
Coordinate corrective action plans with partner/client and TPA/BPO operations services administrator to resolve issues
Support internal plan team members with the resolution of daily issues
Work with other departments to identify and resolve problems leading to incorrect provider data and issues regarding payment of claims
Serve on various committees and attends required meetings.
Able to commute up to 15% to Evolent offices.
Perform other duties and projects as assigned
Key competencies/skill/success factors:
Experience working within a health plan, managed care organization, provider operated healthcare environment or third party administrator
Extensive knowledge of PCs and related software applications, such as Word, PowerPoint, Excel, Project
Demonstrated exceptional active listening and communications skills
Experience in systems and languages related to database lifecycle management such as MS Access, SQL Server, Visual Basic, et
Qualification and Experience:
Associates Degree or equivalent
2-4 years of experience in collecting, analyzing, and presenting data and recommendations to management
Bachelor’s degree in Computer Science, Statistics, Mathematics or related field
1-3 years data analysis and business intelligence experience working with BI suites such as Qlikview, SSRS, Tableau or other enterprise class tools
Prior supervisory or team lead experience
Experience with Medicare Advantage plan
Currently, Evolent employees work remotely temporarily due to COVID-19. As such, we require that all employees have the following technical capability at their home: High speed internet over 10 MBPS and, specifically for all call center employees, the ability to plug in directly to the home internet router. These at-home technical requirements are subject to change with any scheduled re-opening of our office locations.
Evolent Health is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status.
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