The role involves owning the tracking, quantification, and reporting of performance and earned revenue across various health plan incentive programs. You will also partner with senior leadership to inform strategy, resource allocation, and data management pipelines.
The Customer Service Representative will handle inbound and outbound calls from members, providers, and health plans to assist with authorizations, claims, and general inquiries. They are responsible for documenting all interactions in the company system and facilitating member services such as appointment scheduling and transportation arrangements.
The Business Data Analyst is responsible for meeting regulatory reporting requirements for Claims and Provider Dispute Resolution departments. They will design, develop, and manage data systems, reports, and dashboards while conducting root cause analysis to support operational goals.
Develop high-quality data models and scalable ELT pipelines to support internal and external healthcare clients. Implement data quality checks and business intelligence dashboards to drive strategy and improve patient outcomes.
Lead and mentor a team of data engineers to design and implement scalable data pipelines and enterprise-grade ELT processes. Collaborate with cross-functional teams to ensure data quality and align technical solutions with business needs and healthcare regulatory requirements.
Lead the design and execution of the enterprise analytics roadmap, focusing on scalable BI solutions and data governance. Manage a team of professionals to deliver HEDIS quality measurement and Risk Adjustment Factor analytics to improve patient outcomes.
The specialist is responsible for analyzing and executing network development strategies to optimize the Value-Based Care provider network. This includes identifying network gaps, recruiting providers, and coordinating contracting activities to ensure network adequacy.
