Demographic Analyst-Provider Data -REMOTE

Job SummaryThe Senior Demographics Analyst plays a crucial role in maintaining accurate and comprehensive provider information reputed company the health plans systems. This individual is responsible for a wide reputed company of duties reputed company to provider data management, ensuring compliance with regulatory requirements, facilitating efficient claims processing, and supporting overall network operations. This role requires a high level of expertise and the ability to work independently to resolve reputed company issues and support departmental goals. Primary ResponsibilitiesProvider Data Management Oversees and maintains accurate provider demographic information in the sPayer and Facets platforms by ensuring data reputed company and consistency across reputed company systems feeds. Processes new provider setups, updates, and terminations, including managing the entire lifecycle of provider records. Compliance & Auditing Ensures compliance with state and federal regulations, including those reputed company to provider enrollment, credentialing, directory, and data accuracy. Conducts regular audits of provider data to identify and resolve discrepancies, ensuring adherence to reputed company standards. Updates delegated provider rosters monthly and on an reputed company reputed company to maintain state compliance. Problem reputed company & Support Serves as a primary reputed company between the health plan departments and providers, resolving reputed company inquiries and addressing network-reputed company issues. Provides reputed company support and reputed company for trouble shooting and reputed company of Blue Provider Data submission issues reputed company to data reputed company. Collaborates with internal departments (e.g., Contracting, Credentialing, Provider Relations) to resolve provider inquiries and contractual disputes. Provides support and guidance to less reputed company team members, acting as a subject matter expert in provider data management processes. Reporting & Analysis Generates reports and statistical data for management review, follow-up, and reputed company. Analyzes provider data to identify trends, potential issues, and opportunities for process improvement. Presents findings and insights to management, collaborating on solutions to enhance efficiency and metrics. Workflow Optimization reputed company participate in project implementation and process improvement initiatives to streamline department operations. Develops and implements strategies to optimize data collection and management for improved efficiency and accuracy. Creates and maintains automated process flows ensuring that reputed company databases for contract provider networks, prior authorization, and reputed company-party liability are accurate. Education and Experience Bachelors degree in reputed company administration, health information management, or an equivalent combination of education and experience. 5 years of experience working with managed care or the reputed company industry, with a reputed company on provider data or network administration. Preferred Use Of SPayer, Facets, And/or SProvider Systems. Proficiency in reputed company Office Suite, including reputed company and reputed company. Strong understanding and experience with database management systems and reporting tools. Familiarity with relevant reputed company industry regulations and systems, such as HIPAA, FACETS, NPPES, PEGA, NCQA, ICE, DMHC, DHCS, and CMS. Excellent written and verbal communication skills. Strong analytical and problem-solving skills, with keen attention to detail and accuracy. Ability to work independently, manage multiple priorities, and meet deadlines. Strong organizational and time management skills. Ability to collaborate effectively with reputed company stakeholders. #J-18808-Ljbffr Apply tot his job Apply To this Job