Provider Data Operations Jobs in California (NOW HIRING)

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At Hill Physicians Medical Group, we're shaping the healthcare of the future: actively managed care that prevents disease, supports those with chronic conditions and anticipates the needs of our members.

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Hill Physicians has much to offer prospective employees. We're regularly recognized as one of the "Best Places to Work in the Bay Area" and have been recognized as one of the "Healthiest Places to Work in the Bay Area." When you join our team, you're making a great choice for your professional career and your personal satisfaction.

DE&I Statement:

At PriMed, your uniqueness is valued, celebrated, encouraged, supported, and embraced. Whatever your relationship with Hill Physicians, we welcome ALL that you are.

We value and respect your race, ethnicity, gender identity, sexual orientation, age, religion, disabilities, experiences, perspectives, and other attributes. Our celebration of diversity and foundation of inclusion allows us to leverage our differences and capitalize on our similarities to better serve our communities. We do it because it's right!

Job Description:

Reporting to the Manager, Provider Data Management, the Provider Data Analyst supports processes, standards, and other daily provider data operations in the system of record (SOR) Salesforce. The Analyst works closely with health plans and internal partners to ensure provider data is accurately reflected in health plan systems and directories, and internal downstream systems as requested. The Analyst creates reports and dashboards to monitor provider data quality and operational performance. The role leverages approved AI-enabled capabilities to support day-to-day responsibilities and improve efficiency and the integrity of provider data.

ESSENTIAL RESPONSIBILITIES:

Provider Data Management Lifecycle:

• Enter, update, and maintain complete and accurate provider demographic, billing, and 30 contract data (adds/changes/terminations) across systems.

• Ensure provider data is updated in accordance with compliance requirements, processing rules, and guidelines; meet department SLAs and required timelines.

• Track, document, and resolve provider data requests and inquiries through completion; investigate issues, validate corrections, and provide status updates and routine data extracts/reports as needed.

• Create, maintain, and distribute provider rosters (including outreach lists) to validate required information and ensure accuracy, completeness, and timeliness.

• Support internal/external audits and compliance activities (including CA SB 137 quarterly audits) by gathering documentation, completing assigned analysis, and responding to requests within established timelines.

• Create and route provider change request forms and manage provider portal accounts, as assigned.

• Support system enhancements by helping document requirements, executing test cases, and validating results to strengthen data accuracy and controls.

Data Quality and Optimization:

• Support data cleanup and remediation initiatives; assist with meeting coordination, action tracking, and status updates.

• Assist with root-cause, gap, and trend analyses for provider data issues; document findings and share recommendations with the team.

• Maintain working knowledge of provider data sources and end-to-end data flows, including downstream reporting impacts.

• Identify automation opportunities; help define business requirements and validate implemented workflows.

• Use approved AI and automation tools to help streamline data management tasks (e.g., intake triage, validation, deduplication, reconciliation, and exception handling) and track basic metrics that demonstrate efficiency gains.

• Create ad hoc provider roster reports and quality assurance dashboards to support data validation, monitoring, and operational decision-making.

Health Plan & Stakeholder Support:

• Support health plans and external partners regarding provider data, including directory accuracy, routine issue resolution, and audit support, escalating as needed.

• Ensure health plan provider databases and provider directories accurately reflect current provider information by coordinating updates, validations, and reconciliations across systems.

• Provide responsive support for provider data and system-related inquiries; follow troubleshooting steps, communicate status, and escalate issues to the appropriate teams and vendors.

• Log, track, and escalate issues as needed; communicate progress and outcomes through closure to meet time-sensitive needs.

• Provide analytical and administrative support by compiling, summarizing, and formatting data and findings for review by leadership and stakeholders.

• Create and maintain team documentation and training materials to support consistent processes and knowledge sharing.

• Create ad hoc provider rosters and perform data analysis as requested by partner teams to support operational needs, escalations, and audits.

• Support health plan, regulatory, and internal audits by researching items, documenting outcomes, and assisting with corrective action follow-up.

• Assist with provider data discrepancies escalated by practices and partner teams by researching the issue, coordinating corrections, and confirming updates are reflected in downstream systems and deliverables.

General/Other Duties:

• Support provider data projects as assigned.

• Perform other related duties as assigned.

SKILLS AND EXPERIENCE REQUIRED:

• Bachelor's degree required or equivalent experience

• Experience supporting or coordinating projects (e.g., tracking tasks, documenting decisions, communicating status)

• Proficient data analysis skills, including data validation, trend analysis, and root-cause investigation

• Proactive, solutions-oriented approach and comfort adapting to new systems, processes, and regulations

• Ability to prioritize and manage multiple deadlines; strong follow-through and comfort working independently and in a team environment

• Ability to recognize when to ask questions and escalate issues appropriately to meet time-sensitive needs

• Excellent written and verbal communication skills; able to communicate effectively with cross-functional partners

• Demonstrated ability to work accurately under deadlines while balancing competing priorities

• Proficient in Microsoft Office Suite

PREFERRED EXPERIENCE:

• Intermediate Microsoft Excel skills (formulas, filters, pivot tables, and basic reconciliations); ability to work with large datasets

• Experience with reporting/visualization tools (e.g., Tableau) preferred

• Experience using approved AI tools to support data quality and operational workflows

General Competencies

You'll thrive in this role if you:

• Are open-minded and adaptable in a changing environment

• Work as a team player and critical thinker

• Collaborate well and approach problems with curiosity and critical thinking

• Enjoy partnering with others to solve problems and improve outcomes

• Find satisfaction in root-cause analysis and continuous improvement

• Bring strong time management skills and can balance multiple priorities

• Take ownership and follow through to resolve issues in a timely manner

• Have strong organizational skills and consistently high attention to detail

• Communicate clearly and comfortably with partners at all levels, including leadership

Additional Information:

Salary: $70,000 - $88,000 Annual

Hill Physicians is an Equal Opportunity Employer