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Provider Network Intelligence Analyst (Remote

Company: DentaQuest
Location: Hartford
Posted on: June 2, 2021

Job Description:

Location: Remote, Connecticut US

Job Number 3497

Remote, Connecticut US

JOB SUMMARY:Responsible for developing tactical and strategic recommendations for optimization of profitability, clinical performance, member and provider satisfaction, and client satisfaction by leveraging analytic tools, financial models and reports. Conducts and manages analysis based on claims, provider, member, group and related provider data to derive new knowledge from operational, financial and clinical provider databases. Will organize, lead and support efforts to measure, analyze and report on trends enterprise-wide related to the utilization, reimbursements, access to care, cost management, and other high-level metrics to identify and promote strategies to positively influence access to quality, cost and improved program performance. It also works with other areas of the company, including Underwriting, Clinical Management, and Client & Provider Engagement to assist in the understanding of program cost and network trends impacting profitability and to recommend strategies for improvement wherever possible.PRIMARY JOB RESPONSIBILITIES:

Responsible for the tactical and strategic partnership with the network team in identifying, interpreting, prioritizing, designing and procuring analyses to help guide business decisions.

Responsible for partnering with business and clinical teams and other internal clients and resources to enable and execute impactful, accurate business analytics.

Develop and maintain a deep understanding of financial performance metrics with an eye toward identifying and addressing areas of opportunity or risk.

Develop a strong understanding of analytical tools and models to provide analysis of client and provider data.

Lead analytical projects and coordinate with other team members, including programmers to deliver on internal client needs.

Analyze current cost management practices and help to define best practices for: o Outcomes measurement o Provider optimization o Benefit structures and algorithms o System edits, outlier trends, UM and UR o Member behavior management

Monitor and track provider reimbursements to identify strategies to ensure access and profitability targets are met in a manner that is consistent with quality, cost-effective care.

Work with other internal departments as necessary to develop strategies and programs to manage dental costs within each market to assure profitability and budgetary goals.

Provide mentoring and support to internal business partners to increase their overall understanding of cost analysis and therefore increase the business partners' ability to make independent assessments.

Utilize Microsoft Office products to prepare client-friendly materials that comprehensively represent cost provider data.

Provide recommendations on policies, objectives, and initiatives.

Evaluate and suggest changes as necessary to optimize processes and efficiencies.

Participate in special projects as needed or requested.

Analyze leased network provider data (Dentemax, Careington, Other), as well as DCP provider data.

Evaluate partnership network provider data (UHC, Other, DSO).

Provider fee provider data - all o Net effective discount calc o Fair Health provider data o By product: Medicaid, Medicare Advantage, CHP, Exchange, D2C, EPO, PPO

Collect provider data for use in RFP provider data/Bid provider data analysis and prep.

Other duties as needed or required.



Bachelor's degree in Computer Science, Math, Finance or business-related field.

5 years' experience in complex provider data management, analysis and reporting to include experience with combining clinical and financial provider data.

Demonstrated project and client management expertise.

Expert at presenting complex analytic methodology, interpretation, and recommendations to diverse senior-level audiences through visual, verbal and written deliverables.

Expert at identifying appropriate analytic approaches to solve broad business challenges.

Experience with provider database and business intelligence tools.

Strong experience in statistical methods and concepts required.

Demonstrated ability to analyze, solve and interpret complex problems.

Knowledge of provider reimbursement methodologies.

Excellent PC skills with proficiency in MS Office products (Excel, Access, Word, PowerPoint) are essential.

Strong customer service and analytical skills.

Strong project management and process improvement skills.

Ability to lead and work well with others.

Ability to prioritize and organize multiple tasks and remain focused with multiple interruptions.

Ability to meet multiple deadlines.

Comprehensive understanding of business management, research and/or economics is required.

Preferred Qualifications:

Knowledge of health care industry


Incumbent must be able to communicate effectively.

Requires overall light physical effort (up to 25lbs.).

Manual dexterity and sitting are required in carrying out the position's own position responsibilities (i.e. use of a personal computer).

Ability to travel or move about within and outside serviced facilities required.

Incumbent works primarily in either a private or shared office environment.

Webelieve that everyone should live life free of dental disease. As a purpose-driven, double bottom line company that is improving oral health for everyone, we are transforming the oral health system - from the way we provide care and pay for it, to how we talk about it and prioritize it in our policies and communities.

Meaningful change requires a revolution in oral health. We are redefining what it means to prevent disease and provide better access to care for everyone. We are going beyond the dental chair to reshape the oral health system, addressing total health and the social and cultural factors that impact it.

To make this revolution a reality, we harness our unique reach and insights to advance policy, financing, care, and the community. That means solving problems in a flexible and efficient way, testing and trialing to create new solutions and deliveringmeasurableoutcomes for the people we serve.

The people of DentaQuest have a common purpose, and we work together with passion, perseverance and focus to achieve a nation where no child suffers from the pain of tooth decay. Where adults keep all their teeth for their entire lives. Where every person has access to quality dental care.

DentaQuest 465 Medford Street Boston, Massachusetts 02129-1454

Keywords: DentaQuest, Hartford , Provider Network Intelligence Analyst (Remote, Other , Hartford, Connecticut

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