Job Summary:
The Network Adequacy Reporting Analyst II is responsible for analyzing and producing provider network adequacy reporting for CareSource’s various products and provider networks. This role involves ensuring that the network adequacy reports filed with regulators are timely, complete, and accurate, and that data on gaps and exceptions are readily available to the Network Development teams.
Essential Functions:
- Collaborate with internal stakeholders including network management operations and regulatory compliance teams to address network deficiencies
- Generate comprehensive reports on network adequacy metrics, providing insights and recommendations to internal market teams for informed decision-making
- Stay updated on regulatory changes and best practices related to network adequacy requirements
- Prepare HSD and ECP-NA templates for accurate and timely submission
- Perform disruption or prospective analysis of network adequacy reporting and analysis
- Support recurring NCQA network adequacy submissions
- Validate results and findings to ensure accurate reporting and analysis
- Conduct regular assessments and analyses of network adequacy identifying gaps and areas for improvement
- Identify data anomalies/errors and collaborate with provider data management partners to resolve
- Function as a back-up for other team members as required
- Perform any other job-related instructions as required
Education and Experience:
- Bachelor's degree in healthcare administration, business administration, public health, or a related field or equivalent years of relevant experience is required
- Minimum of two (2) years of experience in managed healthcare, network management or reporting is required
- Experience with provider data repositories and directories preferred
Competencies, Knowledge and Skills:
- Proficiency in Microsoft Excel and Access
- Proficiency in T/PL-SQL preferred
- Understanding of healthcare regulations, accreditation requirements, and network adequacy standards for Marketplace, Medicaid Advantage and Medicaid Lines of Business
- Proficiency in data analysis, reporting, and the use of Quest Analytics software for network assessment and reporting
- Analytical mindset with the ability to interpret complex data and make data-driven decisions to improve network adequacy
- Understanding of Cognizant Facets provider data model preferred
- Excellent communication and interpersonal skills, with the ability to collaborate effectively with internal and external stakeholders
- Strong organizational skills and the ability to manage multiple projects and deadlines simultaneously
Licensure and Certification:
- Geo Access certification preferred
Working Conditions:
- General office environment; may be required to sit/stand for long periods of time.
Compensation Range:
$61,500.00 - $98,400.00
CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type (hourly/salary):
Salary
Organization Level Competencies
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Create an Inclusive Environment
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Cultivate Partnerships
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Develop Self and Others
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Drive Execution
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Influence Others
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Pursue Personal Excellence
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Understand the Business
This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an inclusive environment that welcomes and supports individuals of all backgrounds.
Top Skills
What We Do
Health Care with Heart. It is more than a tagline; it’s how we do business. CareSource has been providing life-changing health care to people and communities for nearly 30 years and we will continue to be a transformative force in the industry by placing people over profits.
CareSource is and will always be members first. Even as we grow, we remember the reason we are here – to make a difference in our members’ lives by improving their health and well-being. Today, CareSource offers a lifetime of health coverage to nearly 2 million members through plan offerings including Marketplace, Medicare Advantage and Medicaid. With our team of 4,000 employees located across the country, we continue to clear a path to better life for our members. Visit the "Life" section to see how we are living our mission in the states we serve.
CareSource is an equal opportunity employer and gives consideration for employment to qualified applicants without regard to race, color, religion, sex, age, national origin, disability, sexual orientation, gender identity, genetic information, protected veteran status or any other characteristic protected by applicable federal, state or local law. If you’d like more information about your EEO rights as an applicant under the law, please click here: https://www.eeoc.gov/employers/upload/poster_screen_reader_optimized.pdf and here: https://www.dol.gov/ofccp/regs/compliance/posters/pdf/OFCCP_EEO_Supplement_Final_JRF_QA_508c.pdf
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