Data Analyst for our Pre/PostPay Edit editing program.
This position will provide the technical component of our Pre/PostPay Edit editing program in development, implementation, production monitoring and maintenance of our internal PrePay edits.
Individual will work with our matrix partners to evaluate edit ideas and use business requirements to develop the technical processes to obtain desired results and support strategic initiatives aimed at improving claim accuracy and operational efficiency.
Act as technical analyst for Proactive Claim Intervention projects and daily tasks for all aspects of our Pre/PostPay Edit editing program.
Develop and maintain editing on regular and ad-hoc basis, primarily using SAS, Microsoft SQL Server and internally developed ARM rule-based claim editing platform.
Responsible for data mining activities and technology integration of Pre/PostPay Correction Program to support our Pre/PostPay Edit editing program.
Evaluates and appropriately utilizes various approaches to data mining to narrow in on trends and drivers that directly impact outcomes.
Makes well-thought-out decisions on complex or ambiguous IT architecture issues.
Participate in all phases of Pre/PostPay Edit program IT architecture process testing and implementation.
Ensures that system improvements are successfully implemented and monitored to increase efficiency.
Works closely with matrix business partners to define data needs, opportunities for improvement and effectively communicates results of analysis and solutions.
Acts as a resource for mentorship, training and guidance for junior staff.

Requirements

Bachelor’s degree or higher strongly preferred in Business Analytics, Data Science, Information Systems, or a related field, or equivalent work experience required.
5+ years of experience in healthcare data analytics required.
5+ years coding experience required, with proficient skills using SAS and Microsoft SQL Server highly preferred.
Experience with rule-based editing platforms desired.
5+ years of experience in healthcare data with proficient skills in medical analysis and project management.
Strong data investigation skills to mine healthcare data required.
Experience with Word, Outlook, PowerPoint, Teams, Webex, Excel (pivot tables/VLOOKUP preferred).
Strong data analysis skills with the ability to analyze large amounts of healthcare data to translate complex data into meaningful, actionable insights.
Strong project management skills and comfort in ability to create and achieve success in highly matrixed environment.
Exceptional verbal and written communication skills with demonstrated ability to research, problem solve, trouble shoot, influence and partner across the organization to a drive toward resolution for the client, provider and organization.
Strong presentation skills. Able to prepare, deliver, and ensure understanding of information regarding any customer-related or process improvement topic across audiences.
Demonstrated ability to work independently and drive to objectives.

Benefits

medical
vision
dental
well-being and behavioral health programs
401(k)
company paid life insurance
tuition reimbursement
a minimum of 18 days of paid time off per year
paid holidays

Applicant Tracking System Keywords

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

Hard Skills & Tools

data analysisdata miningSASMicrosoft SQL Serverrule-based editing platformsmedical analysisproject managementdata investigationExcelpivot tables

Soft Skills

communication skillsproblem solvingtroubleshootinginfluencingmentorshiptrainingindependent workpresentation skillsorganizational skillscollaboration