Description

Please note that the resources should check most boxes, particularly experience with QNXT, provider
data, and SQL.
Resources are responsible for evaluation of Provider Group Roster and Provider Data Requests against the QNXT provider data to determine what action is necessary to have the provider data updated in QNXT.
Responsibilities

·        Understands and/or learns the client’s business requirements for
maintenance of provider data within QNXT
·        Develops detailed load requests for updates to the provider data
·        Maintains tracking of work products utilized during the analysis of
QNXT data to the information received from the Provider Group
·        Executes SQL queries to pull QNXT data
·        Runs complex Excel processes to migrate provider data and QNXT
data to perform data validation
·        Troubleshoots data validation issues
·        Performs data analysis using database query tools
·        Identifies risk and/or issues and escalates them appropriately
·        Maintains a favorable working relationship with all project
stakeholders to foster and promote a cooperative and harmonious
working climate which will be conducive to maximum employee morale,
productivity, and efficiency/effectiveness
·        Keeps immediate supervisor promptly and fully informed of all
problems or unusual matters of significance and takes prompt corrective
action where necessary or suggests alternative courses of action

Required Experience/Skills
·        Minimum of eight (8) years working in the health payer industry with
thorough understanding of general business practices and health plan
operations specifically as it relates to Membership, Provider, and Claims
·        5+ years of hands-on QNXT experience – provider model expertise a
major plus
·        5+ years of experience as a Business Analyst or Subject Matter
Expert
·        Solid analytical skills with ability to compile data from many sources
and formulate
·        Excellent data manipulation, communication, analytical and statistical
skills are required
·        Must be comfortable in SQL and MS Excel
·        Must have excellent time management and organizational skills with
the ability to handle multiple tasks in a timely and accurate manner
·        Ability to work under pressure, adhere to deadlines and know when to
escalate information/issues
·        Must have a high level of self-motivation and with little
guidance/supervision

·        Must be able to work both independently as well as a team participant
·        Must have outstanding verbal and written communications skills with
the ability to communicate clearly to all levels of an organization
·        Must have strong interpersonal skills

Preferred Experience/Skills
·        Three (3) plus years health plan operations experience with focus on
provider data and provider data management
·        Knowledge of Medicaid