Provider Data Integrity Analyst - Managed Care/Health Plan

About Texas Children's Hospital

Founded in 1996, Texas Children’s Health Plan is the nation's first health maintenance organization (HMO) created just for children. We provide STAR/Medicaid and Children's Health Insurance Program (CHIP) to pregnant women, teens, children and adults in Houston and surrounding areas. Currently, the Health Plan has more than 375,000 members who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. Texas Children's Health Plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area.   To join our community of 14,000+ dedicated team members, visit texaschildrenspeople.org for career opportunities. You can also learn more about our amazing culture at infinitepassion.org.   Texas Children’s is proud to be an equal opportunity employer. All applicants and employees are considered and evaluated for positions at Texas Children's without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, gender identity, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.

Summary:

We are searching for a Provider Data Integrity Analyst -- someone who works well in a fast-paced setting. In this position, you will be responsible for the monthly audits and reconciliation of all provider data within multiple systems. This role ensures that the Health Plan data is aligned with the States and that all provider updates, including but not limited to adds, terms and changes are being made timely and accurately into our core systems. You will also monitor the reporting of provider data to support the Provider Relations teams, ensuring clean, accurate and timely data related to State regulations.

 

Previous experience in the following is highly preferred -

 

- Managed care/Medicaid

- Loading providers/provider setup using QNXT, Facets, Tapestry or similar system

- Intermediate to advanced Excel skills

 

Think you’ve got what it takes?

Responsibilities :

• Analyze reports and data sets for anomalies within the Provider data from multiple sources
• Manage data discrepancies and maintenance functions in an efficient, secure, timely manner with attention to all defined technical processes and use protocols
• Create and maintain policy and procedures for reconciliation and audit protocols of provider data
• Review updates from the State pertaining to Provider data to ensure that we remain compliant
• Generate data reports on periodic basis as requested or needed for the data management process
• Record and document as required data management activities, including but not limited to service forms, CRM’s, and the Master Provider File
• Address any issues, questions, and problems in accurate and timely manner
• Educate other departments on data use and business rules

Qualifications:

• High school diploma or GED required
• Bachelor’s degree preferred
• 4 years combined managed care contracting, provider reimbursement and analysis, strategic planning and/or project management experience required
• A Bachelor's degree may substitute for the four years of required work experience.

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