Provider Data Management Quality - Hybrid

Interested in a career with both meaning and growth? Whether your abilities are in direct patient care or one of the many other areas of healthcare administration and support, everyone at Parkland works together to fulfill our mission: the health and well-being of individuals and communities entrusted to our care. By joining Parkland, you become part of a diverse healthcare legacy that's served our community for more than 125 years. Put your skills to work with us, seek opportunities to learn and join a talented team where patient care is more than a job. It's our passion.

Primary Purpose Parkland Community Health Plan's (PCHP) Provider Data Management (PDM) Data Quality Analyst is responsible for analyzing, monitoring, and improving the quality of provider data to ensure compliance with organizational and regulatory standards. PCHP is part of Parkland Health. PCHP is a Medicaid Managed Care organization servicing Texas Medicaid and CHIP in the Dallas area.

Minimum Specifications

Education

• Associate's degree required.
• Bachelor's degree in health information management or related field preferred

Experience

• - Two (2) years of experience in a Managed Care health plan or state agency and Provider data management
• - Experience with QNXT or similar claims management & provider data systems preferred.

Equivalent Education and/or Experience

• May have an equivalent combination of education and/or experience in lieu of specific education and/or experience.

Certification/Registration/Licensure Required

Tests for Placement

Skills or Special Abilities

• Strong analytical skills and experience working and manipulating large data sets
• - Proficiency in data visualization tools (i.e., Tableau, Power BI) -
• Proficiency with provider data and management systems (e.g., QNXT, credentialing platforms). -
• Proficiency with Microsoft Office Suite. -
• Strong understanding of regulatory compliance requirements for provider data processes. -
• Strong problem-solving skills and ability to work in a fast-paced environment. -
• Excellent verbal and written communication skills. -
• Excellent problem-solving skills and critical thinking ability. -
• Knowledge of Texas Medicaid Health Plan (TMHP) and TX HHSC Medicaid requirements is preferred.

Responsibilities

- Operations Develop and execute data quality checks to ensure provider data accuracy and integrity across all systems and files. Analyze provider data for trends, inconsistencies, and gaps, recommending solutions to address identified issues. Collaborate with IT team and other stakeholders to address data quality issues and implement corrective actions. Document and maintain Policies and Procedures (P&Ps) and Desk Level Procedures (DLPs) related to provider data quality processes. - Quality Assist in development and maintenance of data quality dashboards and reports. Integrate health literacy principles into all communication including Members and Providers. Support strategies that meet clinical, quality and network improvement goals. Promote the use of Health Information Technology to support and monitor the effectiveness of health and social interventions and make data-driven recommendations as needed. For staff in clinical roles, foster collaborative relationships with members and/or providers to promote and support evidence-based practices and care coordination. - Regulatory Participate in audits and compliance reviews, ensuring provider data meets organizational and regulatory requirements. Support preparation and submission of regulatory files, ensuring data accuracy and timeliness. Ensures work is carried out in compliance with regulatory and/or accreditation standards as well as contractual requirements. - Professional Accountability Promotes and supports a culturally welcoming and inclusive work environment. Acts with the highest integrity and ethical standards while adhering to Parkland's Mission, Vision, and Values. Adheres to organizational policies, procedures, and guidelines. Completes assigned training, self-appraisal, and annual health requirements timely. Adheres to hybrid work schedule requirements. Attends required meetings and town halls. Recognizes and communicates ethical and legal concerns through the established channels of communication. Demonstrates accountability and responsibility by independently completing work, including projects and assignments on time, and providing timely responses to requests for information. Maintains confidentiality at all times. Performs other work as requested that is reasonably related to the employees position, qualifications, and competencies.

Parkland Health and Hospital System prohibits discrimination based on age (40 or over), race, color, religion, sex (including pregnancy), sexual orientation, gender identity, gender expression, genetic information, disability, national origin, marital status, political belief, or veteran status.As part of our commitment to our patients and employees' wellness, Parkland Health is a tobacco and smoke-free campus.