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.

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.

Medical, dental and vision coverage for employees and their eligible family members, including mental health benefits.
Annual employer contribution to a health savings account.
Generous paid time off varying by role and tenure in addition to 10 company-paid holidays.
Market-leading retirement plan including a company match on employee 401(k) contributions, with a potential discretionary contribution based on company performance (no vesting period).
Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service with Cambia immediately preceding leave).
Award-winning wellness programs that reward you for participation.
Employee Assistance Fund for those in need.
Commute and parking benefits.

Provider Network Data Adequacy Analyst

Key skills