Health Care Business Analyst - Provider Services

Central Coast Salary Range: $74,023 - $107,333 Annually

Job Summary

The Provider Services Health Care Business Analyst reports to the Provider Services Quality & Network Development Manager. This role is responsible for preparing provider network analyses and reporting for the Provider Services Department. The Health Care Business Analyst also participates in workgroups and committees focused on enhancing provider data integrity and improving the design of the provider maintenance subsystem. This position conducts both basic and complex analyses to monitor provider data, support daily operations, and ensure compliance with regulatory reporting requirements.

Duties and Responsibilities

• Prepares provider network analyses and leads reporting activities for the Provider Services Department. Utilizes in-depth knowledge of the provider network to conduct research, interpret, and evaluate provider data. Generates reports to assess access to care and services for health plan members.

• Creates reports and conducts analyses for the Network Management Committee, CenCal Health’s Board of Directors, and regulatory agencies such as the Department of Healthcare Services and Managed Healthcare. Designs geoaccess and other reports as required, providing recommendations for improvements.

• Acts as a subject matter expert on provider data requirements mandated by the Department of Healthcare Services, including SB 274 and SB 137.

• Coordinates provider reimbursement and configuration efforts within the Provider Services Department, overseeing contract implementation and reviewing State operating instruction letters.

• Serves as a system configuration resource for Provider Relations Representatives and Data Specialists. Manages provider configuration projects initiated by CenCal Health staff or required by regulatory agencies, ensuring compliance with business rules.

• Participates in the System Change Form (SCF) workgroup and other cross-departmental teams. Acts as a liaison to the Information Technology Department, leading technical projects, including system change submissions, and ensuring accurate implementation.

• Responds to requests for provider information mandated by the State Department of Health Services, the Medical Risk Management Insurance Board, and other governing bodies, ensuring timely delivery.

• Recommends process and system improvements. Assists the Provider Services Department with special projects and other duties as assigned.

Knowledge/Skills/Abilities

• Exceptional analytical and research abilities

• In-depth knowledge of managed care programs, with a focus on Medi-Cal

• Proficient in computer systems, including system configuration

• Excellent interpersonal and team collaboration skills

• Outstanding oral and written communication abilities

• Strong time management and project management skills

• A solid understanding of provider data and complex departmental and agency processes and procedures

Education and Experience

• Bachelor's degree preferred; Associate’s degree considered with relevant work experience

• Three to five (3-5) years of experience in a healthcare setting (e.g., health plan, clinic, or medical group)

• Three to five (3-5) years of experience in analytical work using PC-based software applications, particularly Excel