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:
$60,300.00 - $96,500.00 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. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type:
Salary

Competencies: