Provider Network Operations Data Analyst

Role Overview: The Provider Network Operations Data Analyst plays a key role in maintaining accurate provider data and fostering strong relationships between the health plan and its contracted and non-contracted providers across Medicaid, Medicare, and Exchange products. This role ensures provider information is correctly represented in all operating systems and serves as a proactive liaison to resolve provider-related issues efficiently.

Work Arrangement:

• Remote – The associate can work remotely from anywhere in the Detroit Metro area, Michigan, and must be able to attend two weeks of in-office training at our Southfield, Michigan, location.

Responsibilities:

• Serve as a primary point of contact for providers, ensuring timely resolution of inquiries and issues.
• Communicate plan policies, procedures, and regulatory updates clearly and professionally.
• Maintain and monitor provider data to ensure accuracy across all systems.
• Review and process provider data intake forms for completeness.
• Track and document provider data changes to ensure timely updates and compliance with turnaround standards.
• Escalate discrepancies or requests that conflict with business processes or contract terms.
• Ensure timely and accurate management of provider contracts, including terms and reimbursement details.
• Investigate and respond to member complaints within established timelines.
• Identify and report compliance issues in accordance with plan policies and procedures.
• Demonstrate working knowledge of provider databases (e.g., Facets) and reimbursement methodologies.
• Collaborate with internal departments to manage medical costs and support strategic initiatives.
• Demonstrates working knowledge of Facets, particularly the provider database, and consistently communicates updates, such as additions, deletions, or corrections, to the provider maintenance department.

Education & Experience:

• Bachelor’s degree or equivalent work experience required.
• At least one year of experience working with healthcare providers and provider relations
• 3 years of experience in managed care or health insurance preferred.
• Proficiency in Microsoft Excel & Access (formulas, pivot tables, charts/graphs).
• Strong analytical skills (non-IT focused)