Provider Services Healthcare Business Analyst

Central Coast Salary Range:  $95,062 - $137,840

Job Summary

The Provider Services Health Care Business Analyst is a key technical role within the Provider Services Department, and is responsible for conducting advanced data analyses, developing complex provider network reports, and leading provider data configuration efforts to ensure operational and system efficiency. The Health Care Business Analyst collaborates with cross-functional teams, leverages data to support decision-making, and driving improvements to enhance provider network performance. This position also acts as a subject matter expert on provider data standards and contributes to system enhancements to optimize the accuracy, accessibility and usability of provider data across the organization.

Duties & Responsibilities

• Advanced Data Analysis, Report and Data Management:
  • Develops complex data analyses and predictive models to assess provider network performance, monitor access to care, and identify trends affective provider and member outcomes.
  • Leads the provider data reconciliation of CenCal Health’s provider network data.
  • Designs, builds, and maintains interactive dashboards and reports for internal stakeholders, including the Network Management Committee, CenCal Health’s Board of Directors, and regulatory agencies such as the Department of Healthcare Services and Centers for Medicare & Medicaid Services.
  • Acts as a subject matter expert on provider data integrity and compliance, ensuring adherence to state and federal regulations, including SB 274 and SB 137.
  • Develops and oversees strategies for improving provider data accuracy and completeness, supporting regulatory reporting, and enabling strategic decision-making.
  • Leads the creation of geo-access and other reports, providing actionable insights and recommendations to improve access to care and optimize provider network development.
• Provider Configuration:
  • Manages complex provider reimbursement and configuration projects, ensuring alignment with state guidance and organizational priorities.
  • Oversees the accurate implementation of provider contracts and configuration changes.
  • Participates in the development of business rules for system configuration to support regulatory and operational needs.
• Cross-Functional Collaboration and Process Improvement:
  • Serves as a technical and analytical resource in cross-departmental workgroups, such as the System Change Form (SCF) workgroup, leading provider-related system enhancements and process improvements.
  • Collaborates with IT to scope, recommend, and implement system change requests, ensuring that projects meet organizational goals and compliance standards.
  • Provides analytical and technical support to Provider Services and Provider Relations for strategic initiatives and process improvement efforts.
  • Identifies opportunities to enhance provider network operations and ensure compliance through innovative tools and systems.
• Other Responsibilities:
  • Prepares data analyses and reports required by governing bodies such as the Department and Centers for Medicare & Medicaid Services.
  • Ensures all regulatory reporting deadlines are met with accuracy and provides recommendations to mitigate compliance risk.
  • Recommends process and system improvements. Assists the Provider Services Department with special projects and other duties as assigned.

Knowledge/Skills/Abilities

• Exceptional data analysis, statistical modeling, and trend analysis skills
• Proficiency with analytical and data visualization tools
• In-depth knowledge of managed care programs, with a focus on Medi-Cal
• Familiarity with CMS and DHCS network adequacy and compliance standards
• Experience with system configuration and optimizing healthcare IT systems
• Ability to manage large datasets and create actionable insights
• Excellent interpersonal and team collaboration skills
• Outstanding oral and written communication abilities
• Strong time management and project management skills
• Skilled in identifying and solving complex operational and data challenges

Education & Experience

• Bachelor's Degree required and Master’s degree preferred, with at least 3 years of experience in a healthcare setting, or a combination of academic, professional or work experience that demonstrates ability to perform duties of the position
• Three to five (3-5) years of experience in analytical work using PC-based software applications, particularly Excel