Provider Data Analyst - 26-54 at Hill… · San Ramon

Summary: Hill Physicians Medical Group is shaping the healthcare of the future through actively managed care. The Provider Data Analyst supports provider data operations, ensuring accuracy in health plan systems and creating reports to monitor data quality and operational performance. Responsibilities: - Enter, update, and maintain complete and accurate provider demographic, billing, and contract data (adds/changes/terminations) across systems - Ensure provider data is updated in accordance with compliance requirements, processing rules, and guidelines; meet department SLAs and required timelines - Track, document, and resolve provider data requests and inquiries through completion; investigate issues, validate corrections, and provide status updates and routine data extracts/reports as needed - Create, maintain, and distribute provider rosters (including outreach lists) to validate required information and ensure accuracy, completeness, and timeliness - Support internal/external audits and compliance activities (including CA SB 137 quarterly audits) by gathering documentation, completing assigned analysis, and responding to requests within established timelines - Create and route provider change request forms and manage provider portal accounts, as assigned - Support system enhancements by helping document requirements, executing test cases, and validating results to strengthen data accuracy and controls - Support data cleanup and remediation initiatives; assist with meeting coordination, action tracking, and status updates - Assist with root-cause, gap, and trend analyses for provider data issues; document findings and share recommendations with the team - Maintain working knowledge of provider data sources and end-to-end data flows, including downstream reporting impacts - Identify automation opportunities; help define business requirements and validate implemented workflows - Use approved AI and automation tools to help streamline data management tasks (e.g., intake triage, validation, deduplication, reconciliation, and exception handling) and track basic metrics that demonstrate efficiency gains - Create ad hoc provider roster reports and quality assurance dashboards to support data validation, monitoring, and operational decision-making - Support health plans and external partners regarding provider data, including directory accuracy, routine issue resolution, and audit support, escalating as needed - Ensure health plan provider databases and provider directories accurately reflect current provider information by coordinating updates, validations, and reconciliations across systems - Provide responsive support for provider data and system-related inquiries; follow troubleshooting steps, communicate status, and escalate issues to the appropriate teams and vendors - Log, track, and escalate issues as needed; communicate progress and outcomes through closure to meet time-sensitive needs - Provide analytical and administrative support by compiling, summarizing, and formatting data and findings for review by leadership and stakeholders - Create and maintain team documentation and training materials to support consistent processes and knowledge sharing - Create ad hoc provider rosters and perform data analysis as requested by partner teams to support operational needs, escalations, and audits - Support health plan, regulatory, and internal audits by researching items, documenting outcomes, and assisting with corrective action follow-up - Assist with provider data discrepancies escalated by practices and partner teams by researching the issue, coordinating corrections, and confirming updates are reflected in downstream systems and deliverables - Support provider data projects as assigned - Perform other related duties as assigned Required Qualifications: - Bachelor's degree required or equivalent experience - Experience supporting or coordinating projects (e.g., tracking tasks, documenting decisions, communicating status) - Proficient data analysis skills, including data validation, trend analysis, and root-cause investigation - Proactive, solutions-oriented approach and comfort adapting to new systems, processes, and regulations - Ability to prioritize and manage multiple deadlines; strong follow-through and comfort working independently and in a team environment - Ability to recognize when to ask questions and escalate issues appropriately to meet time-sensitive needs - Excellent written and verbal communication skills; able to communicate effectively with cross-functional partners - Demonstrated ability to work accurately under deadlines while balancing competing priorities - Proficient in Microsoft Office Suite Preferred Qualifications: - Intermediate Microsoft Excel skills (formulas, filters, pivot tables, and basic reconciliations); ability to work with large datasets - Experience with reporting/visualization tools (e.g., Tableau) preferred - Experience using approved AI tools to support data quality and operational workflows Required Skills: Salesforce, Provider data management, Data analysis, Data validation, Root-cause analysis, Microsoft Office Suite, Microsoft Excel, Tableau