Senior Business Analyst, Provider Network Management and Administration

The Senior Business Analyst, Provider Network Administration & Enablement, will be a key contributor to the design, execution, and enablement of the provider network strategy. This role requires a strong background in healthcare administration, with extensive knowledge of provider contracts, payment methodologies, and medical claim pricing. The ideal candidate will be adept at analyzing complex healthcare data, reading and interpreting provider contracts, and translating business needs into actionable solutions. This position will support the Senior Director and collaborate with cross-functional teams to enhance network efficiency, data accuracy, and overall cost-effectiveness.

What you'll do:

• Provider Contract & Pricing Analysis
  • Analyze and interpret complex provider contracts to ensure accurate data administration and system configuration.
  • Support the configuration of new provider contracts and network initiatives by translating contract terms, including pricing and payment methodologies, into clear business requirements.
  • Conduct detailed analysis of medical claims data to validate claim payments against contract terms and pricing schedules.
  • Identify and document discrepancies or issues in claims processing related to provider contracts and pricing, and work with relevant teams to resolve them.
  • Assist in the development and maintenance of scalable processes for managing provider contracts and pricing data.
• Data Management & Analytics
  • Develop and maintain reporting and dashboards to monitor key performance indicators (KPIs) related to provider data accuracy, network adequacy, and payment trends.
  • Support the implementation and maintenance of data quality standards and procedures.
  • Utilize data analysis to identify gaps in geographic and specialty coverage within the provider network.
  • Partner with the Data & Analytics team to create and refine analytical tools and reports that inform decision-making and support network strategy.
• Collaboration & Project Support
  • Serve as a subject matter expert on provider contracts and pricing for internal stakeholders, including product, engineering, and claims operations teams.
  • Collaborate with cross-functional teams to support the onboarding and maintenance of provider contract data.
  • Assist in the preparation of materials and presentations for leadership and external stakeholders.
  • Support the team's compliance efforts by assisting with routine audits and ensuring data integrity in alignment with CMS and state regulations.

To be successful in this role, you'll need:

• Required: Bachelor's degree in Healthcare Administration, Business, Finance, or a related field.
• 7+ years of experience as a business analyst or similar role within the healthcare industry.
• Required: Extensive experience in reading and interpreting provider contracts and payment methodologies, including fee-for-service, capitation, bundled payments, and value-based care models.
• Required: Proven experience in analyzing medical claims and pricing data.
• Strong analytical and problem-solving skills with the ability to translate complex data and contract terms into clear, actionable insights.
• Proficiency in data analysis tools (e.g., SQL, Excel, Tableau).
• Excellent communication and interpersonal skills, with the ability to collaborate effectively with technical and non-technical stakeholders.
• Familiarity with healthcare industry regulations and data privacy standards (e.g., HIPAA).

Pay Transparency Statement 

This is a hybrid position based out of one of our offices: Plano, TX, or Lehi, UT. Hybrid employees are expected to be in the office two days per week.#LI-hybrid 

The actual pay rate offered within the range will depend on factors including geographic location, qualifications, experience, and internal equity. In addition to the salary, you will be eligible for stock options and benefits like health insurance, 401k, and paid time off. Learn more about our benefits at https://jobs.collectivehealth.com/benefits/.