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Claims Data Intelligence Analyst

Company: CareSource
Location: Dayton
Posted on: December 9, 2018

Job Description:

Role and Responsibility: * Perform analysis of all claims data in order to provide decision support to Claims leadership team * Generate graphics that effectively describe, explore and summarize information for communication to appropriate parties * Work collaboratively in business units in identification, communication, execution, and management of appropriate system metrics and controls * Generate data from various databases and sources in order to identify trends throughout the Claims department * Generate and supply Regulatory and Compliance reporting * Ensure data integrity of all submissions with claims reimbursement methodologies * Monitor performance and quality control plans to identify improvements * Identify payment integrity issues with claims reimbursement methodologies * Provide Claims Subject Matter Expertise (SME) for cross-functional meetings including operational and new business implementation * Lead Claims initiatives such as working with IT and others to automate claim functions; and report development * Lead Claims initiatives such as working with IT and others to automate claim functions; improve data collection and submission functions, improve front end paper claim process, report * Contribute to and/or develop user stories or provide user story guidance for sprint planning * Implement new business including the design, testing and delivery of supporting processes to the business * Identify trends and patterns using standard departmental reports and databases as well as leveraging other processes and data sources * Represents the Claims department in project meetings and other meetings that require subject matter knowledge and input * Perform any other job related instructions, as requested Requirements Education / Experience: * Bachelor's degree or equivalent years of relevant work experience is required * Minimum of five (5) years of experience in data analysis is required * Training in statistical process control methodology preferred * Healthcare delivery and/or payer experience is preferred Required Competencies / Knowledge / Skills: * Advanced proficiency with Microsoft Suite to include, Excel, Word, Power Point, Access and Outlook * Intermediate knowledge of SQL, SAS or other data manipulation software * Strong analytical skills with the ability to collect, organize, analyze, and disseminate significant amounts of information with attention to detail and accuracy * Knowledge of managed care preferred * Knowledge of healthcare data coding such as CPT-4, HCPCS, ICD-9, ICD-10, DRG and Revenue Codes preferred * Data analysis and trending skills * Graphic development/presentation skills strongly preferred * Communication skills both written and verbal * Critical listening and thinking skills * Ability to work independently and within a team environment * Strong interpersonal skills and high level of professionalism * Strong problem solving skills and attention to detail * Strong listening and critical thinking skills Licensure / Certification: * None Working Conditions: * General office environment; may be required to sit/stand for long periods of time Apply On-lineSend This Job to a Friend Copyright ? Ultimate SoftwareSDL2017

Keywords: CareSource, Dayton , Claims Data Intelligence Analyst, Professions , Dayton, Ohio

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