Provider-Reporting Analyst

Description

JOB SUMMARY

The Provider-Reporting Analyst is responsible for reviewing, maintaining, and supporting provider configuration data to ensure accuracy, compliance, and operational efficiency. This role manages provider setup, fee schedule review, reporting development, and supports onboarding functions within the Managed Care (MCR) Eligibility & Benefits department. The Analyst will also develop complex reports and dashboards to support business operations, decision-making, and performance monitoring.

Requirements

MINIMUM & PREFERRED QUALIFICATIONS

Education/Training

Minimum: Bachelor's degree in Healthcare Administration, Business Administration, Public Health, Data Analytics, or related field.

Preferred: Master's degree in Healthcare Administration, Public Health, or related field.

Experience 

Minimum: 3+ years of Managed Care Eligibility & Benefits or healthcare administrative experience.

Preferred: Experience in managed care, MSO, IPA, or health plan settings; familiarity with member eligibility, eligibility files, and systems such as EZ-CAP.

Any combination of educational and work experience that would be equivalent to the stated minimum requirements would qualify for consideration of this position.

Skills, Knowledge & Abilities

· Working knowledge of provider data structures, contract terms, and reimbursement methodologies (e.g. Medicare, carve-outs, case rates, flat/base rates).

· Understanding of managed care operations, provider networks, credentialing, and basic claims concepts.

· Experience using EZ-CAP or similar managed care/claims systems.

· Basic understanding of fee schedule setup, mapping, and system maintenance.

· Familiarity with RAF scoring and its relevance to reporting or configuration.

· Ability to use reporting tools such as Crystal Reports, Tableau, Excel, and basic SQL.

· Strong analytical and critical-thinking skills; ability to follow detailed workflows.

· Ability to interpret contracts and translate requirements into system setup.

· Effective collaboration with internal teams (Provider Relations, IT, Finance, Claims, etc.).

· Strong documentation skills and commitment to accuracy.

· Ability to manage confidential information appropriately.

· Adaptability in a changing environment with evolving business and regulatory needs.

· Willingness to learn new systems, tools, and technologies.

PHYSICAL, MENTAL & ENVIRONMENTAL REQUIREMENTS

The physical, mental, and environmental demands described here are representative of those required to successfully perform the essential functions of this job. The Provider-Reporting Analyst role requires the ability to maintain sustained focus while working extensively with computers and detailed data, often sitting or standing for extended periods. The position demands strong mental concentration to analyze information, troubleshoot issues, and uphold accuracy in a dynamic environment with evolving operational and regulatory needs. This role must be able to move through office settings as needed, participate in cross -departmental interactions, and manage confidential information responsibly while adapting to shifting priorities and workflows.