Operations Analyst, Network Operations

Position Summary:

The Operations Analyst will analyze provider and operational data to inform the tactical decisions of Alignment’s provider network.  The role requires comfort with ambiguity and an ability to find solutions.  The analyst will support Alignment’s Network Operations team with a focus on provider directory, provider data quality, contract management, and partner with the network team with day-to-day functions. This role will report to the Director of Network Operations.

General Duties/Responsibilities (May include but are not limited to):

·         Analyze and report on complex provider data

·         Determine, evaluate, and make priority recommendations on business metrics to meet Operational needs

·         Create and update operational procedures, business rules, forms, and policies.

·         Coordinate quarterly CMS roster validation. Track and monitor provider responses.

·          with development of departmental KPI’s.  Partner with leadership in developing and analysis of department KPIs.Analyze contract language and collaborate with the Finance department for provider incentive payouts.

·         Run and critically evaluate quality control processes on provider directory data.

·         Create compliance reporting and conduct audits.

·         Using excel, the Microsoft suite, and various other software platforms, manage both project and task-based work.

·         Improve processes by studying current practice and designing modifications; actively participate in the implementation of approved changes.

·         Perform related duties similar to the above in scope and function as required.

Minimum Requirements:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.  The requirements listed below are representative of the knowledge, skill, and/or ability required.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1.       Minimum Experience:

b.       Familiarity with Value-based healthcare systems.

2.       Education/Licensure:

a.         Bachelor's Degree (BA) from a four-year college or university, or one to two years of related experience and/or training, or equivalent combination of education and experience.

3.       Other:

a.       Ability to work with Director and VP level in creating requirements for new initiatives.

b.       Proven problem-solving skills and ability to translate knowledge to the department.

c.       Intermediate to Advanced experience and skills with Microsoft Office Products.Strong knowledge of Excel (Pivot tables, VLOOKUP’s, Macros)

d.       Ability to create actionable plans through the use of data analysis.

e.       Demonstrated track record of generating results and having an impact on projects.

f.        Strong database and/or analytical tool experience.

g.       Innovative in problem-solving, planning, and strategizing.

h.       Articulate & persuasive in presenting business-case for change management, where required.

1. Work Environment

1. 1. The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Essential Physical Functions:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.
2. The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.