Your Future Evolves Here
Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving force that brings us to work each day. We believe in embracing new ideas, challenging ourselves and failing forward. We respect and celebrate individual talents and team wins. We have fun while working hard and Evolenteers often make a difference working in everything from scrubs to jeans.
Are we growing? Absolutely and Globally. In 2021 we grew our teams by almost 50% and continue to grow even more in 2022. Are we recognized as a company you are supported by for your career and growth, and a great place to work? Definitely. Evolent Health International (Pune, India) has been certified as “Great Places to Work” in 2021. In 2020 and 2021 Evolent in the U.S. was both named Best Company for Women to Advance list by Parity.org and earned a perfect score on the Human Rights Campaign (HRC) Foundation’s Corporate Equality Index (CEI). This index is the nation's foremost benchmarking survey and report measuring corporate policies and practices related to LGBTQ+ workplace equality.
We recognize employees that live our values, give back to our communities each year, and are champions for bringing our whole selves to work each day. If you’re looking for a place where your work can be personally and professionally rewarding, don’t just join a company with a mission. Join a mission with a company behind it.
What You’ll Be Doing:
Job Description
Evolent Health is looking for a Provider Data Specialist to be a key member of the PDM Operations team. Reporting to the Supervisor of Provider Data Management, this individual will play a critical role in executing Evolent Health’s mission by working directly with our partners, focused on coordinating, monitoring, trending and supporting report requirements of business operational and clinical programs within Provider Network Management. This Provider Data Analyst will work with both internal and external business partners to implement ongoing operational monitoring, resolve service barriers, develop solutions to improve effectiveness and identify continuous improvement initiatives to increase service levels.
Essential functions
Serve as a liaison between the internal team members and partner organization providing support for provider data enrollment activities; acts as liaison with technology team and business product team members.
Oversee and mentor a team of data analysts, providing guidance, feedback, and support to enhance their performance.
Defines analysis methodology and provides analytic support.
Analyzes existing systems to recommend enhancements and creates new systems to reduce manual processes and maximize the business efficiencies.
Analyzes data from conceptualization through presentation and requires proficiency with analytical tools, knowledge of data analysis methodology, use of presentation software, and strong communication skills.
Evaluate and recommend data tools, software, and platforms to improve analysis capabilities.
Identifies, evaluates, and implements new data-driven strategies and processes for the department
Develops tools and reports that lend valuable insights that capitalize on a combination of internal and external data.
Recommends enhancements to existing systems in accordance to business needs by creating ad hoc and standard reports as well as information delivery technologies.
Prepare reports in an accurate, concise and timely fashion.
Provide guidance and support to all claims and operations personnel towards resolution of provider data and claims problems with an emphasis on root cause analysis and resolution of problems
Compile, review and analyze management reports and take appropriate action
Identify and advise Claims, Provider Network Management, Medicare Operations and other operational areas of trends, problems, and issues as well as recommended course of action; ensure timely communication; participate in the development and implementation of solutions
Monitor adherence to the efficiency and service level goals including volume, processing, timeliness, accuracy and other metrics.
Develop deep understanding of processing capabilities and limitations of claims and benefits with TPA/BPO systems, tools and resources; provide recommendations to meet plan requirements
Create and report operational tracking metrics and dashboards for monitoring claims, provider disputes and benefits performance.
Support internal plan team members with the resolution of daily issues.
Work with other departments to identify and resolve problems leading to incorrect provider data and issues regarding payment of claims.
Serve on various committees and attends required meetings.
Key competencies/skill/success factors:
Experience working within a health plan, managed care organization, provider operated healthcare environment or third party administrator
Good Knowledge on Python, SQL Server- SSMS, SSRS.
Extensive knowledge of PCs and related software applications, such as Word, PowerPoint, Excel, Project
Demonstrated exceptional active listening and communication skills
Experience in systems and languages related to database lifecycle management such as MS Access, Visual Basic, etc
Qualification and Experience:
Required
Associates Degree or equivalent
7+ years of experience in collecting, analyzing, and presenting data and recommendations to management
Big plus
Bachelor’s degree in Computer Science, Statistics, Mathematics or related field
4 - 5 years data analysis and business intelligence experience working with BI suites such as Power BI, SSRS or other enterprise class tools
Mandatory Requirements:
We require that all employees have the following technical capability at their home: High speed internet over 10 Mbps, the ability to plug in directly to the home internet router. These at-home technical requirements are subject to change with any scheduled re-opening of our office locations.
Evolent Health is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status.
Top Skills
What We Do
Evolent Health delivers proven clinical and administrative solutions that improve whole person health while making health care simpler and more affordable. Our three solutions—Evolent Care Partners, New Century Health and Evolent Health Services—encompass total cost of care management, specialty care management and administrative simplification. Evolent serves a national base of leading payers and providers, is the first company to receive the National Committee for Quality Assurance's Population Health Program Accreditation, and is consistently recognized as a top place to work in health care nationally.
OUR PEOPLE
We were named one of “Becker’s 150 Great Places to Work in Healthcare” in 2016, 2017, 2018 and 2019 and are proud to be recognized as a leader in driving diversity, equity, and inclusion (DE&I) efforts. Evolent achieved a 100% score on the 2020 Human Rights Campaign's Corporate Equality Index, making us one of the best places to work for LGBTQ+ employees. We were also named on the Best Companies for Women to Advance List 2020 and 2021 by Parity.org.
OUR CULTURE
Our accessible leadership team cultivates an open-door environment. We don’t like approval chains; we love ideas and people with the courage and conviction to bring novel solutions forward. We win as a team and always ask how we can do better. We respect and encourage commitments outside of work.
OUR COMPENSATION & BENEFITS
We recognize and reward our most valuable asset—our team—with competitive pay and annual performance-based bonuses. Evolent also offers comprehensive health benefits, a company-matched 401(k) and flexible spending accounts. Every salaried Evolent employee receives unlimited Personal Time Off and is eligible for a month-long sabbatical after working five years with Evolent.
This account is monitored closely by our company. Please message us at [email protected] with any questions or concerns.
