Provider Directory Assurance Analyst

Job description

Under the general direction of the Supervisor, PNO Process Improvement & Analytics, and technical guidance from the Lead, Provider Directory Assurance Analyst, the Provider Directory Assurance Analyst is responsible for ensuring the accuracy, completeness, and timely reporting of Client IPA provider network data to Health Plans and regulatory entities. This role supports provider directory validation, network data reconciliation, and regulatory reporting requirements. The Analyst monitors data integrity, conducts quality assurance reviews, and collaborates with internal departments to identify and resolve provider data discrepancies, while supporting continuous improvement in provider data quality and reporting processes.

Duties and Responsibilities:

Prepare and submit required provider directory and network validation reports to Health Plans and regulatory entities in accordance with established reporting schedules (monthly, quarterly, and ad-hoc).

Conduct routine data reconciliation between Client IPA provider databases, Health Plan provider rosters, and internal operational systems to ensure provider directory accuracy.

Perform quality assurance reviews of provider demographic, participation, and network data to ensure compliance with contractual, regulatory, and organizational requirements.

Investigate and resolve provider data discrepancies, coordinating corrections with Provider Database Management, Provider Network Management, and other operational teams.

Develop and distribute operational reports supporting Provider Network Operations, Credentialing, Utilization Management, Compliance, and Client leadership teams.

Analyze provider network data to identify trends, reporting inconsistencies, and opportunities to improve data accuracy and reporting efficiency.

Maintain clear communication with department leadership regarding provider data integrity issues, reporting outcomes, and potential compliance concerns.

Support departmental initiatives related to data cleanup, reporting automation, workflow optimization, and ongoing database maintenance.

Perform additional duties and special projects as assigned to support Provider Network Operations and organizational goals.

High School Diploma or GED required; Bachelor's degree in Healthcare Administration, Business Administration, Information Systems, Data Analytics, or related field preferred

Strong proficiency in Microsoft Office Suite, particularly Excel

Experience with healthcare provider data, reporting, or network operations preferred

Experience with EZ-CAP or similar managed care platforms preferred

Knowledge of Access, SQL, Power BI, or other data analysis tools preferred

Skills and Abilities:

Strong analytical and problem-solving skills with the ability to interpret and validate complex data sets

Advanced Excel capabilities, including Pivot Tables, formulas, and data reconciliation techniques

Exceptional attention to detail and commitment to data accuracy

Manage multiple reporting deadlines and competing priorities

Strong written and verbal communication skills with the ability to present findings clearly

Work independently while collaborating effectively across departments

Learn and adapt quickly to new systems, reporting tools, and regulatory requirements

Demonstrates professionalism and alignment with the organization’s core values

Salary Range:

$25.50 - $29.50 hourly

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Worksite address

los angeles, CA, 90079, US

Who can apply

Review the original listing for work authorization, qualifications and employer requirements.