Provider Network Intelligence Analyst, DentaQuest

Responsible for developing tactical and strategic recommendations for optimization of profitability, clinical performance, member and provider satisfaction and client satisfaction by leveraging analytic tools, financial models and reports. Conducts and manages procurement of analysis based on claims, provider, member, group and related data to derive new knowledge from DentaQuest's operational, financial and clinical databases. Will organize, support efforts to measure, analyze and report on trends enterprise-wide related to utilization, reimbursements, access to care, cost management, and other high-level metrics to identify and promote strategies to positively influence access to quality, cost and improved program performance. This position will also work with other areas of the company, including Underwriting, Clinical Management and Client & Provider Engagement to assist in the understanding of program cost and network trends impacting profitability and to recommend strategies for improvement wherever possible.

How you will contribute:

• Responsible for tactical and strategic partnership with the CPE team in identifying, interpreting, prioritizing, designing and procuring analyses to help guide business decisions.

• Responsible for partnering with business and clinical teams and other internal clients and resources to enable and execute impactful, accurate business analytics.

• Develop and maintain deep understanding of financial performance metrics with an eye toward identifying and addressing areas of opportunity or risk.

• Create, generate and maintain reports related to network composition and/or expansion through MS-Excel, MS-Access, SQL, SAS, Power BI and Quest Analytics. Populate and analyze operational reports as needed for filling RFP, RFR, and/or any network expansion requirements.

• Maintains current knowledge of DentaQuest benefits, provider reimbursement methodologies, provider contracts, State regulations, claims adjudication and other party liability procedures.

• Responsible for the structure, design, and integrity of all data within Network Development Provider and Reimbursement database.

• Develop a strong understanding of analytical tools and models to provide analysis of client and provider data.

• Lead analytical projects and coordinate with other team members, including programmers to deliver on internal client needs.

• Analyze current cost management practices and help to define best practices for:

  • Outcome measurement

  • Provider optimization

  • Benefit structures and algorithms

  • System edits, outlier trends, UM and UR

  • Member behavior management

• Monitor and track provider reimbursements to identify strategies to ensure access and profitability targets are met in a manner that is consistent with quality, cost effective care.

• Work with other internal departments as necessary to develop strategies and programs to manage dental costs within each market to assure profitability and budgetary goals.

• Provide support to internal business partners to increase their overall understanding of cost analysis and therefore increase the business partners' ability to make independent assessments.

• Utilize Microsoft Office products to prepare client-friendly materials that comprehensively represent cost data.

• Provide recommendations on policies, objectives and initiatives.

• Evaluate and suggest changes as necessary to optimize processes and efficiencies.

• Participate in special projects as needed or requested.

• Analyze leased network data (Dentemax, Careington, Other), as well as DCP data

• Evaluate partnership network data (UHC, Other, DSO)

• Provider fee data - all

  • Net effective discount calc

  • Fair Health data

  • By product: Medicare Advantage, Exchange, D2C, EPO, PPO

• Collect data for use in RFP data/Bid data analysis and prep

• Other duties as needed or required.

What you will bring with you:

Required:

• Bachelor's degree in Computer Science, Math, Finance or business-related field or equivalent experience.

• 3 years' experience in complex data management, analysis and reporting to include experience with combining clinical and financial data.

• Demonstrated project and client management expertise.

• Expert at presenting complex analytic methodology, interpretation and recommendations to diverse senior-level audiences through visual, verbal and written deliverables.

• Expert at identifying appropriate analytic approaches to solve broad business challenges.

• Experience with database and business intelligence tools.

• Strong experience in statistical methods and concepts required.

• Demonstrated ability to analyze, solve and interpret complex problems.

• Knowledge of provider reimbursement methodologies.

• Excellent PC skills with proficiency in MS Office products (Excel, Access, Word, PowerPoint) are essential.

• Strong customer service and analytical skills.

• Strong project management and process improvement skills.

• Ability to lead and work well with others.

• Ability to prioritize and organize multiple tasks and remain focused with multiple interruptions.

• Ability to meet multiple deadlines.

• Comprehensive understanding of business management, research and/or economics is required.

Preferred Qualifications:

• Knowledge of health care industry

Salary:

Salary Range: $67,300 - $101,000

At our company, we are committed to pay transparency and equity. The salary range for this role is competitive nationwide, and we strive to ensure that compensation is fair and equitable. Your actual base salary will be determined based on your unique skills, qualifications, experience, education, and geographic location. In addition to your base salary, this position is eligible for a discretionary annual incentive award based on your individual performance as well as the overall performance of the business. We are dedicated to creating a work environment where everyone is rewarded for their contributions.