Provider Network Data Adequacy Analyst

Provider Network Data Adequacy Analyst

Hybrid opportunity in Portland, OR;
Medford, OR;
Lewiston, ;
Boise, ;
Renton, WA;
Burlington, WA;
Vancouver, WA;
Spokane, WA;
Salt Lake City,

Build a career with purpose. Join our Cause to create a person-focused and economically sustainable health care system.

Every day, Cambia’s dedicated team of Provider Network Data Adequacy Analyst are living our mission to make health care easier and lives better. As a member of the Network Innovations and Analytics team, our Provider Network Data Adequacy Analyst produces and analyzes provider network adequacy reports to assess healthcare access. They provide data-driven recommendations to Network VPs on network modifications that improve member access and deliver greater value – all in service of making our members’ health journeys easier.

Do you have a passion for data analysis and improving healthcare access? Do you thrive in a role that combines analytical expertise with strategic recommendations? Then this role may be the perfect fit.

Network Adequacy & Access Analyst would have a bachelor's degree in Business, Health Care Administration, Data Analysis, or related field and 5 years of related experience or equivalent combination of education and experience.

• Experience in health plan/payor environment with provider data, network development, and network analysis
• Proficiency in database query tools and methodology (SQL, Oracle, Greenplum, Toad, MS Access)
• Strong organizational skills to manage multiple projects simultaneously and meet deadlines
• Ability to derive insights from data regarding network access and provider value of care by specialty
• Self-directed work style with flexibility to coordinate complex, rapidly changing activities
• Proficient in MS Office with aptitude for learning new corporate software
• Proven project management and analytical capabilities with minimal supervision required
• Excellent written and oral communication skills; experience with AI tools highly desired

• Responsible for ensuring Cambia is meeting network adequacy requirements for Medicare Advantage and Qualified Health Plan networks, as well as local regulatory network adequacy requirements across a broad range of specialties and geographies.
• Conducts regulatory filings and submission of required reporting for provider network adequacy and access to maintain compliance with state, federal, and CMS requirements, and resolves all questions, issues, and objections related to such filings, such as Medicare HSD tables.
• Responsible for analysis of access gaps and opportunities by provider specialty, and consolidating data for the purpose of recommending network changes.
• Responsible for assessing provider networks using efficiency and effectiveness data for the purpose of network architecture.
• Provides analytical support and supports internal customers with network assessments and corrective actions to address network deficiencies and opportunities.
• Evaluate existing network adequacy policies and procedures, including verification of compliance standards, lead implementation of recommended updates, and development of new policies and procedures.
• Performs regular network adequacy evaluations to support provider contract negotiations, provider terminations, and provider network optimization.
• Produce summaries that interpret network adequacy and access report outcomes and findings and suggest strategies and recommendations for improvement to contracting teams.

The expected hiring range for the Provider Network Data Adequacy Analyst is $92,700 - $103,600 depending on skills, experience, education, and training; relevant licensure / certifications; and performance history. The bonus target for this position is 15% target. The current full salary range for this role is $87,000 - $142,000.

Working at Cambia means being part of a purpose-driven, award-winning culture built on trust and innovation anchored in our 100+ year history. Our caring and supportive colleagues are some of the best and brightest in the industry, innovating together toward…