Provider Network Quality Analyst

MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlusHealth network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlus has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.

Position Overview

MetroPlusHealthis committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day.

This position will ensure overall network compliance with regulatory requirements governing plan's provider network. In addition, will perform required surveys such as access and availability, annual attestations as well as conduct quality activities such as ensuring provider complaints are addressed and properly communicated. This role will also measure and analyze the quality and consumption of provider data and ensure accuracy of plan's provider information inclusive of provider directory.

• Oversee and coordinate the administration of provider network surveys, such as Provider Satisfaction, Provider Access and Availability, and Secret Shopper surveys.
• Analyze survey outcomes, identify trends and opportunities for provider education and network expansion
• Assess key access indicators to ensure provider compliance and network adequacy standards and drafting corrective action plans, as required
• Coordinate regulatory reporting, the submission of audit-related deliverables, and policy review
• Ensure providers appearing in provider directories, addendums, and the web-directory are contracted and demographic information is accurate and up-to-date.
• Assess accuracy, completeness, and currency of Networks, Contracts, Demographic and Reimbursement data within MetroPlusHealth's systems; process change requests to the Credentialing department; and confirm updates in the CACTUS and PowerSTEPP software applications
• Assist in provider data quality assurance program and participate in developing policies and procedures.
• Monitor and ensure provider complaints are resolved timely and outcome communicated to provider as appropriate; track and trend provider complaints and recommend areas for improvements
• Conduct investigation of providers who are identified to be non-compliant based on the New York State Department of Health telephone surveys for appointment accessibility, telephone accessibility, and demographic content for accuracy of both MetroPlusHalth on-line search tool and printed provider directories.
• Assist with clearing conditions on previously audited files (may be reviewed by another member of the project review team).
• Responsible for data collection, data extraction, data analysis, and data reporting activities such as provider counts, panel reports, and reports for regulators.
• Conduct independent and/or collaborative data analysis to improve the quality in Provider data for our customer, client, and provider experience of quality outcomes
• Works with delegated entities to ensure data is accurate
• Act as liaison between the Credentialing, Provider Maintenance, and Customer Service departments
• Investigate and respond to inter-departmental project-related inquires.
• Ensure Plan receives respective annual attestation from providers
• Performs other support activites and duties as assigned

• Requires a Bachelor's degree; and
• 3-5 years experience in a research or provider data management position; or
• A satisfactory equivalent combination of education, training, and experience
• Ability to analyze and interpret legal, regulatory and contractual language
• Ability to assist with the development and implementation of projects, systems, programs, policies, and procedures
• Ability to travel to meet with Providers and their representatives
• Ability to exercise tact and diplomacy and demonstrate strong customer service skills
• Ability to independently manage assigned workload, make decisions related to area of functional responsibility, and recognize issues requiring escalation
• Ability to prepare written and oral reports and make effective presentations
• Ability to identify issues, conduct research, analyze and interpret data, reach logical and sound conclusions, and make recommendations for action
• Ability to work independently and prioritize initiatives to meet report deadlines and thrive in a busy and dynamic work environment is a must
• Working knowledge of and proficiency with Windows-based PC systems and Microsoft Word, Outlook, Excel, PowerPoint, SharePoint

Professional Competencies

• Integrity and Trust
• Customer Focus
• Highly organized, detail oriented, dependable and professional individual

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