Provider Network Data Adequacy Analyst

Cambia Health Solutions is dedicated to creating a person-focused and economically sustainable health care system. They are seeking a Provider Network Data Adequacy Analyst to produce and analyze provider network adequacy reports, providing data-driven recommendations to improve member access and deliver greater value in healthcare services.

Responsibilities:

• 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