Dental Home Network Analyst
The Dental Home Network analyst manages the assignments of members to primary care dental offices. By assessing member assignments through reporting, regular auditing and working with various functional areas, this role ensures members are assigned to their appropriate dental home so they are able to access the oral health care they need. It is essential the Dental Home Network analyst possesses strong analytical and problem-solving skills in order to identify and resolve contrary assignment trends. Additionally, this role supports implementations by attending meetings with internal and external customers and completing all tasks relating to the set-up and maintenance of a new dental home market.
PRIMARY JOB RESPONSIBILITIES:
- Monitors dental home market performance through regular auditing of provider set-ups, system configuration, auto-assignment results and peer assessments.
- Ensures success of dental home market through audit and data analysis and makes recommendations for improvements when necessary.
- Takes appropriate action to keep the unassigned member counts at or below standard.
- Supports dental home implementations by attending implementation calls with clients and internal customers, completing appropriate tasks and auditing and providing feedback on technical outcomes.
- Produces and analyzes dental home reports, identifies contrary trends and takes corrective measures to prevent negative impacts to clients and/or internal customers.
- Understands and complies with all client and regulatory requirements relating to Dental Home.
- Maintains documentation for assigned Dental Home markets.
- Assesses current processes and makes recommendations for efficiencies and other improvements.
- Works as part of a highly functioning team and provides support to peers.
- Collaborates with Managers of Provider Networks & Specialty Networks, Provider Engagement and other functional areas to adjust member assignments/provider scoring in an efficient and effective manner to have a positive financial impact on the business.
- Assesses member movement requests and makes recommendations on how to better meet the needs of the requestor when necessary.
- Performs all necessary administrative functions consistent with company policies.
- Performs other duties as assigned.
JOB REQUIREMENTS:
- Bachelor’s Degree in Business Administration or a related field 2 years of experience in the health insurance field. PC skills: Microsoft Excel – Advanced level, Microsoft Word - Intermediate level and Microsoft Access – Intermediate level, including, but not limited to, Visual Basic; SharePoint experience is a plus.
- Proven ability to resolve complicated requests requiring numerous steps, from start to finish. Proven solid analytical and problem-solving skills.
- Proven ability to provide consultative services to meet client and internal customer needs.
- Attention to detail and persistence when addressing day-to-day assignments and solving problems.
- Proven ability to learn, analyze, and master new computer systems, applications and processes with minimal instruction. Proven effective organizational skills.
- Proven ability to understand process flows and downstream impacts of actions.
- Proven effective communication skills in English and Spanish in some markets, both written and oral.
- Proven discretion in handling confidential data.
- Initiative: Self-starter with proven ability to conceive and prepare comprehensive, detailed data analyses.
- Ability to work in excess of 40 hours per week as needed or required to meet business objectives.
- Travel less than 5%.
- Required to attend additional training as requested/deemed necessary.