Provider Data Analyst - 26-54

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At Hill Physicians Medical Group, we’re shaping the healthcare of the future: actively managed care that prevents disease, supports those with chronic conditions and anticipates the needs of our members.

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Hill Physicians has much to offer prospective employees.  We’re regularly recognized as one of the “Best Places to Work in the Bay Area” and have been recognized as one of the “Healthiest Places to Work in the Bay Area.” When you join our team, you’re making a great choice for your professional career and your personal satisfaction.

DE&I Statement:

At PriMed, your uniqueness is valued, celebrated, encouraged, supported, and embraced. Whatever your relationship with Hill Physicians, we welcome ALL that you are.

We value and respect your race, ethnicity, gender identity, sexual orientation, age, religion, disabilities, experiences, perspectives, and other attributes. Our celebration of diversity and foundation of inclusion allows us to leverage our differences and capitalize on our similarities to better serve our communities. We do it because it's right!

Job Description:

Reporting to the Manager, Provider Data Management, the Provider Data Analyst supports processes, standards, and other daily provider data operations in the system of record (SOR) Salesforce. The Analyst works closely with health plans and internal partners to ensure provider data is accurately reflected in health plan systems and directories, and internal downstream systems as requested. The Analyst creates reports and dashboards to monitor provider data quality and operational performance. The role leverages approved AI-enabled capabilities to support day-to-day responsibilities and improve efficiency and the integrity of provider data.

ESSENTIAL RESPONSIBILITIES:

Provider Data Management Lifecycle:

• Enter, update, and maintain complete and accurate provider demographic, billing, and 30 contract data (adds/changes/terminations) across systems.

• Ensure provider data is updated in accordance with compliance requirements, processing rules, and guidelines; meet department SLAs and required timelines.

• Track, document, and resolve provider data requests and inquiries through completion; investigate issues, validate corrections, and provide status updates and routine data extracts/reports as needed.

• Create, maintain, and distribute provider rosters (including outreach lists) to validate required information and ensure accuracy, completeness, and timeliness.

• Support internal/external audits and compliance activities (including CA SB 137 quarterly audits) by gathering documentation, completing assigned analysis, and responding to requests within established timelines.

• Create and route provider change request forms and manage provider portal accounts, as assigned.

• Support system enhancements by helping document requirements, executing test cases, and validating results to strengthen data accuracy and controls.

Data Quality and Optimization:

• Support data cleanup and remediation initiatives; assist with meeting coordination, action tracking, and status updates.

• Assist with root-cause, gap, and trend analyses for provider data issues; document findings and share recommendations with the team.

• Maintain working knowledge of provider data sources and end-to-end data flows, including downstream reporting impacts.

• Identify automation opportunities; help define business requirements and validate implemented workflows.

• Use approved AI and automation tools to help streamline data management tasks (e.g., intake triage, validation, deduplication, reconciliation, and exception handling) and track basic metrics that demonstrate efficiency gains.

• Create ad hoc provider roster reports and quality assurance dashboards to support data validation, monitoring, and operational decision-making.

Health Plan & Stakeholder Support:

• Support health plans and external partners regarding provider data, including directory accuracy, routine issue resolution, and audit support, escalating as needed.

• Ensure health plan provider databases and provider directories accurately reflect current provider information by coordinating updates, validations, and reconciliations across systems.

• Provide responsive support for provider data and system-related inquiries; follow troubleshooting steps, communicate status, and escalate issues to the appropriate teams and vendors.

• Log, track, and escalate issues as needed; communicate progress and outcomes t