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Claims Data Intelligence Analyst

Company: CareSource
Location: Dayton
Posted on: January 14, 2019

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 Software

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

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