[Remote] Provider Network Data Integrity Analyst - Health Plan

Note: The job is a remote job and is open to candidates in USA. Sanford Health, the largest rural health system in the United States, is dedicated to transforming the health care experience and providing access to world-class health care in America’s heartland. This position is responsible for the accuracy, completeness, and required regulatory filings of the Health Plan’s provider network, ensuring compliance with established standards and maintaining data integrity. The role involves strategic planning, compliance, and network analysis to support the Health Plan's operations.ResponsibilitiesDevelops and enforces data quality standards within the provider and facility database to ensure that credentialing software is a source for up to date accurate record informationCompletes network adequacy reviews, in collaboration with the Health Plan's Business Intelligence Department representatives to include Center for Medicare and Medicaid Services (CMS) time and distance standards, ensuring HP meets required network standards to expand their service areaPerforms analyses and audits to identify gaps in current provider networks to ensure corrections are made by contracting to maintain compliance with required adequacy standardsCoordinates required regulatory provider network submissions to ensure HP meets contractual obligationsAudits and advises provider credentialing on identified data issues, including working with delegated credentialed entities, to ensure that complete and accurate information is being receivedMaintains accurate data in HP Provider Directory to ensure it's in compliance with CMS, Department of Health Services (DHS), and Office of the Commissioner of Insurance requirementsOrganizes a large amount of data into easy to understand formats to help aid in strategic planning for HPMaintains a strong understanding of providers and facilities in current HP's service area and patterns of care to help identify opportunities for potential expansionResearches and communicate regulatory directives to ensure HP maintains compliant practicesPerforms disruption analysis for potential customers of HP to identify potential improvements to effectively provide competitiveness for bidsOther duties as assignedSkillsBachelor's Degree in business administration, finance, healthcare related field, computer science, or analyticsThree years' experience in a medical group practice, health insurance or Health Maintenance Organization (HMO) environmentDemonstrated knowledge of data manipulation and analytical analysisProficiency with Microsoft Office suite to include products, Excel and AccessSuccessful completion of a post-secondary medical terminology courseUnderstanding of geoaccess coding, provider credentialing, and medical terminologyCompany OverviewSanford is a healthcare company providing research, education and clinical care. It was founded in 1894, and is headquartered in Sioux Falls, South Dakota, USA, with a workforce of 10001+ employees. Its website is http://www.sanfordhealth.org.Company H1B SponsorshipSanford Health has a track record of offering H1B sponsorships, with 14 in 2026, 26 in 2025, 37 in 2024, 37 in 2023, 51 in 2022, 64 in 2021, 30 in 2020. Please note that this does not guarantee sponsorship for this specific role.