Network Analysis & Monitoring Specialist

Exempt

GENERAL DESCRIPTION:

Responsible for preparing and analyzing reports that support negotiation and contracting strategies with providers, including facilities, hospitals, ancillary services, and professional services. This position contributes to projects focused on cost savings and operational efficiency by compiling and interpreting data on provider utilization and network performance. Supports the administrative and operational processes of provider network management in alignment with departmental strategies.

ESSENTIAL FUNCTIONS:

• Analyzes provider utilization trends and performance metrics to support contracting, renewals, and operational planning.
• Prepares reports and dashboards using various data sources to ensure alignment with departmental objectives.
• Prepares comprehensive reports to monitor the quality and utilization metrics of facilities and providers while also addressing assigned regulatory reporting requirements. Contributes to the development of summaries and reports for management and cross-functional teams, ensuring a unified approach to data analysis and reporting. Additionally, contributes to the creation of recurring and ad hoc reports based on business needs.
• Conducts data validation and applies business logic to ensure the accuracy and relevance of provider data.
• Supports the review and update of provider network documentation, including directories and contract tracking.
• Handles internal requests for network data and provider information, ensuring timely and accurate responses. Additionally, addresses Request for Proposal (RFP) inquiries by compiling and analyzing network directory data for both business lines.
• Manage all Network Adequacy Reports requests for internal or external purposes.
• Prepares cost and utilization summaries that help evaluate the financial impact of provider agreements.
• Collaborates with internal departments to align data interpretations and reporting outputs.
• Participates in the refinement of reporting tools and templates to improve efficiency and consistency.
• Identifies data inconsistencies or trends that may affect contract negotiations or network operations.
• Complete assignments that require knowledge of provider contracting and managed care operations.
• Must comply fully and consistently with all company policies and procedures, with local and federal laws as well as with the regulations applicable to our Industry, to maintain appropriate business and employment practices.
• May carry out other duties and responsibilities as assigned, according to the requirements of education and experience contained in this document.

Education and Experience: Bachelor’s degree in Business Administration, preferably in Accounting, Finance, or Health-related areas. At least three (3) years of experience in data analysis, utilization, trend analysis, negotiation of facilities, and/or service contracting agreements with providers, preferably in the Healthcare Industry or related areas.

“Proven experience may be replaced by previously established requirements.”

Certifications / Licenses: N/A

Other: N/A

Languages:

Spanish – Advanced (comprehensive, writing, and verbal)

English – Advanced (comprehensive, writing, and verbal)

“We are an Equal Employment Opportunity Employer and take Affirmative Action to recruit Protected Veterans and Individuals with Disabilities.”