Provider Network Analyst - TPA

Location: Fort Lauderdale, FL
Date Posted: 02-01-2018
Provider Network Analyst - Managed Care 
Fort Lauderdale, FL
Job Summary:
The Provider Network Analyst supports the research and analyses of new and existing provider networks. They will support the Network Management team as needed. Update and compile reports for Health Plans, Providers and internal departments. Support the department in completing and tracking of client audits. Learn various internal software to assist in utilization reviews and adequacy of provider networks. 

Position Description: 
  • Conducts research and analyses of new and existing provider networks.
  • Participates in the development of new target networks in a strategic geographic location.
  • Participates in network related user training and documentation.
  • Coordinates and manages provider communications, education and network support activities.
  • Serves as liaison between network development team and internal/external business partners.
  • Maintains and utilizes provider data from different corporate systems and external sources to assist in preparing network reports, analyses and presentations.
  • Complies data, tracks data and supports other network development, network relations and network education needs.
  • Prepares materials for conferences and workshops.
  • Maintain spreadsheets and databases; collect, track, prepare, compile, and distribute statistical data for daily and ad hoc reports.
  • Interface with credentialing staff to ensure data and systems are in sync.
  • Provide support to contract negotiators to ensure successful completion of contracting process.
  • Identify gaps and risk in contracting process and coordinate with multiple departments to ensure contracting process is completed timely and accurately and within required established standards and guidelines.
  • Maintain physical and electronic file systems.
  • Provide support to other departments to ensure compliance with corporate contracting standards. 
Requires a Bachelor's degree in healthcare or business related field, or additional years of directly applicable experience.
Requires 2-3 years related experience with contract language, contract development, negotiation, or administration, including using experience with SQL, GeoMaps and Lookup
Prefer healthcare experience and experience with the credentialing/contracting process in the MCO environment.
Prefer experience with community resources (Medicaid providers, etc).
Must be able to work effectively with common office software, such as SharePoint, Excel, Word, Outlook, PowerPoint, and web browsers.
Must be willing and able to travel in the area.
The Reward:
Work with an exceptional organization focused exclusively on promoting the health care and quality of life for its members.  The forward-looking health plan has a demonstrated passion for finding innovative ways to enhance member’s ability to manage their own health.
CareNational Healthcare Services
623.201.8732 (CALL – TEXT – FAX)
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