Delta Dental of Iowa seeks a Provider Data Analyst. As part of the Professional Relations team, you will be responsible for clinical analytics, provider data management and utilization reporting of suspected fraud and abuse to manage network providers. This includes compiling data from multiple sources, completing data analysis, converting data into knowledge, communicating findings and making recommendations for improvement related to all activities that support the corporate, operational, quality, and contractual objectives of Delta Dental of Iowa networks. As a Provider Data Analyst, you will be detail-oriented, analytical, and curious.
Delta Dental of Iowa provides dental and vision insurance to more than 1 million Iowans. As a not-for-profit insurance company, our mission is to improve the health and smiles of the people we serve. We give back to Iowa communities by supporting and funding health and wellness initiatives that make a measurable difference in the overall health of underserved Iowans. Come see why we are passionate about "Bringing Smiles" to our customers. Our team enjoys competitive pay and benefits, an awesome "One Team" approach, and a company culture that fosters "Exceptional Quality Service" and "Leadership at All Levels." Love where you work!
Essential Functions and Principal Accountabilities:
- Generate and analyze reports to identify statistical aberrant treatment profiles; evaluate targeted claims for utilization review, appropriateness, and adherence to national processing policies; work with appropriate staff to educate dentists and dental office staff to appropriate treatment reporting and compliance to Delta Dental of Iowa processing policy.
- Perform annual fee schedule analysis for all Delta Dental of Iowa networks.
- Develop and maintain procedure code guidelines based on DDPA policy and current CDT version.
- Assist in the development, analyzing and distributing of reports and analysis related to requested deliverables, including ad hoc data requests.
- Perform deep dive analysis to effectively translate broad data sets into performance insight; present findings and recommendations to multiple levels of management.
- Assist in the creation and management of all necessary provider reporting to contribute to the overall success of Delta Dental of Iowa networks.
- Report, analyze and summarize data for cost containment reports, dental consultant activity and other required department reporting.
- Utilize Business Objects, SQL, and other tools to mine database(s) for analytic data.
- Support the team to ensure appropriate metrics are developed, analyzed and distributed to monitor pre and post payment utilization review.
- Effectively communicate results to stakeholders.
- Ensure department knowledge and understanding of reports that are developed to educate our providers. Maintain strict confidentiality; adherence to all HIPPA laws is required at all times.
- Perform other duties as assigned.
- Bachelor’s degree in business, finance, mathematics, or related field with three to five years of work experience in population health, financial, or operational data analysis.
- Insurance experience is strongly preferred, dental experience a plus.
- Must possess superior math and impact analysis skills.
- Ability to work as an analytical, problem solver who can make high quality judgments and decisions quickly with excellent organization skills to work across functions, with internal leadership, and external customers.
- Experience using critical thinking skills working with results, metrics and data management and desire to create and build new processes.
- Strong collaboration skills and the ability to work effectively on project teams, as well as independently.
- Excellent verbal, written and communication skills working with all levels of employees, including Leadership.
- High level of proficiency with Microsoft Office applications and strong working knowledge of database environments required.
- Previous Business Objects and SQL experience preferred.
Delta Dental of Iowa is an Affirmative Action and Equal Opportunity Employer committed to providing equal employment opportunity for all persons without unlawful regard of race, color, religion, sex, sexual orientation, gender identity, age, national origin, individuals with disabilities, protected veteran status, or any other legally protected basis.
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