Responsible for state and federal submissions in an accurate and timely manner
Accountable for regulatory reporting within the organization and government entities
Reconciling encounter data and providing root cause analysis of rejections with member eligibility, provider, medical & pharmacy data elements, and claim payment information with high integrity
Continuously monitor the statuses of existing processes and identify discrepancies or process improvements
Actively participate in the development, testing, and implementation of file extracts and layouts to meet vendor and regulatory agency requirements
Must possess excellent analytical skills with a focus on meeting the expectations and requirements of both internal and external customers
Contribute to our humble pursuit of excellence by performing various responsibilities that may arise, reflecting our collective goal of enhancing healthcare delivery and being the difference for the customer.

Requirements

An Associate Degree in Health Administration, business, economics, computer science
Three years of experience in a business environment involving the analysis of healthcare or health insurance data sets
SQL (Intermediate). Able to write and debug queries
Python. Able to write and debug python scripts
Proven ability to pull, analyze, report, and provide insight on large complex sets of data
Ability to identify areas of process improvement and implement automation efficiencies
Curiosity to foster innovation and pave the way for growth
Humility to play as a team
Commitment to being the difference for our customers in every interaction

Benefits

Growth opportunities to uplevel your career
A people-centric culture embracing and celebrating diverse perspectives, backgrounds, and experiences within our team
Competitive compensation and comprehensive benefits focused on well-being

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools

SQLPythondata analysisroot cause analysisregulatory reportingfile extractsdata reconciliationprocess improvementautomationhealthcare data analysis

Soft Skills

analytical skillscustomer focusteamworkcuriosityhumilitycommitment to excellenceproblem-solvingcommunicationattention to detailinnovation

Certifications

Associate Degree in Health AdministrationAssociate Degree in businessAssociate Degree in economicsAssociate Degree in computer science