Provider Data Consultant

Job Summary

A company is looking for a Provider Data and Claims Consultant, Remote.

Key Responsibilities

• Support behavioral health member and provider operations through pricing integrity audits and provider pick integrity programs
• Conduct market audits, analysis, reporting, and remediation as part of a workgroup
• Assess provider pick job aids and provide recommendations for rules engine development while acting as operational backup

Required Qualifications

• 3+ years of data analysis and/or audit experience in the healthcare industry
• 3+ years of claims analysis and/or claims audit experience
• Advanced understanding of UHG provider data, including knowledge of NDB, OHBS Facets, or CSP Facets
• Experience leading cross-functional workgroups and defining detailed requirements for automation or user tools
• Intermediate proficiency with Microsoft Excel