Senior Provider Data Integrity Analyst - The Health Plan - Remote Position

 
Position: Senior Provider Data Integrity Analyst - The Health Plan - Remote Position

Job ID: 161953

Location: US-TX-Houston

Department: PROVIDER DATA INTEGRITY TEAM

Talent Area: Professional - Non-Clinical

Full/Part Time: Full-Time

Regular/Temporary: Regular

Shift: 8a - 5p Monday - Friday

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.  At Texas Children’s Hospital, diversity, equity, and inclusion are at the core of our values and mission for the women and children that we serve. We are committed to providing a diverse and inclusive work environment for all faculty, staff and learners throughout our organization. We believe that each member of our one amazing team provides enrichment that allows us to create a lasting legacy for future employees of this great organization.   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’ll provide daily oversight, monitoring and continuous quality improvements within the Provider Data Integrity team. You’ll create and maintain data sets that link provider data across multiple applications. You’ll review and analyze data systems to ensure integrity and consult with customers to identify / improve operational procedures. You’ll also report creation and presentation to senior leadership, provide full end to end workflow documentation and lead interdepartmental collaboration for data mining and analysis.

Think you’ve got what it takes?



Responsibilities :

Job Duties & Responsibilities

  • Create and maintain discrepancy reporting using SQL queries and Business Intelligence tools
  • Analyze data to identify trends, patterns and opportunities for business operations
  • Evaluate datasets for consistency, completeness, accuracy and reasonableness
  • Always maintain data standards in alignment with the State and other Regulatory requirements
  • Create and maintain solid P&P’s
  • Create and maintain Provider Data Integrity Business rules
  • Develop and maintain data dictionaries
  • Validate data entry and data set maintenance functions in a systemic approach to ensure timely and accurate updates
  • Identify data inaccuracies
  • 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
  • Partner with IS through system configurations changes and upgrades


Qualifications:

Skills & Requirements

  • Being fully vaccinated against COVID-19, including any booster dose(s) of the COVID-19 vaccine recommended by the Centers for Disease Control when eligible, is required for all employees at Texas Children’s, unless approved for a medical or religious exemption.
  • High School Diploma or GED Required
  • 5 Years Of Combined Managed Care Contracting, Provider Reimbursement And Analysis, Strategic Planning And/Or Project Management Experience Required

**SQL experience highly preferred for this role**



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