Senior Provider Data Integrity Analyst - 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 Senior Provider Data Integrity Analyst -- someone who works well in a fast-paced setting. In this position, you will be responsible for the creation of provider data discrepancy reporting between multiple systems and the State. You will provide daily oversight, monitoring and continuous quality improvements within the Provider Data Integrity team. You will also create and maintain data sets that link provider data across multiple applications, review and analyze data systems to ensure integrity, consult with customers to identify / improve operational procedures, and lead report creation and presentation to senior leadership.

 

Preferred experience -

 

Advanced proficiency in Microsoft Excel and SQL

Managed care/Medicaid/Provider data

 

Think you’ve got what it takes?

Responsibilities :

• Create and maintain discrepancy reporting using SQL queries and Business Intelligence tools
• Oversee technical accuracy, data integrity, and reconciliation of provider data
• Validate data entry and data set maintenance functions in a systemic approach to ensure timely and accurate updates
• Manage the regular report running schedule and processes related to providers and data sets
• Develop presentation content to summarize and explain findings, trends and patterns
• Facilitate business process and data review with other departments to determine and implement best practices
• Educate other departments on provider data use in all systems

Qualifications:

• High school diploma or GED required
• 5 years combined managed care contracting, provider reimbursement and analysis, strategic planning and/or project management experience required
• Experience in writing SQL queries, Data Mining, and Data Analysis
• Experience with the health-insurance industry, specifically managed-care operations, and reimbursement analysis techniques
• A Bachelor's degree may substitute for the four years of required work experience

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